Edward Peters IV, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005114 Issued in MI

Practice address

1002 Old U.S. 27
St. Johns, MI 48879

Phone

(989) 224-3937

NPI assigned

Jun 19, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Michigan College of Medicine and Surgery, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avery Vision Center PCGroup PAC ID 5698851319, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Avery Vision Center PC

  • Optometrist
  • St Johns, MI
  • NPI 1174677959
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1134613680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 OLD U.S. 27",
            "city": "ST. JOHNS",
            "state": "MI",
            "postal_code": "48879",
            "telephone_number": "989-224-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 OLD U.S. 27",
            "city": "ST. JOHNS",
            "state": "MI",
            "postal_code": "48879",
            "telephone_number": "989-224-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Patterson, L.L.P.C.
• Mary Ann Paxton
• PDS I Michigan Inc
• Pebble Creek Counseling LLC
• David L. Peters, O.D.
• Edward A Peters III, OD
• Zachary B Peters, OD
• Bailey Phinney
• Jessica Polen
• Soledad Poquiz, PHYSICAL THERAPIST

• Optometrist in St. Johns, MI
• Providers in St. Johns, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.