Active NPI
David James Peterson, O.D.
- Optometrist
- Fairbanks, AK
National Provider Identifier
1164411930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2496
- Practice address
- 116 Minnie St
Fairbanks, AK 99701-3006 - Phone
- (907) 456-7760
- Fax
- (907) 328-1867
- NPI assigned
- Oct 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2496 | MN | Primary |
| Optometrist | 152W00000X | 358 | AK |
Addresses
Primary practice location
116 Minnie St
Fairbanks, AK 99701-3006
Mailing address
116 Minnie St
Fairbanks, AK 99701-3006
Phone (907) 456-7760
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2496 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480377600000",
"number": "1164411930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 MINNIE ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997013006",
"telephone_number": "907-456-7760",
"fax_number": "907-328-1867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 MINNIE ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997013006",
"telephone_number": "907-456-7760",
"fax_number": "907-328-1867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DAVID",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-14",
"last_updated": "2016-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2496",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AK",
"license": "358",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.