Kenneth a Peterson

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

CA 9884T Issued in CA

Legal business name

KENNETH A PETERSON

Practice address

911 Oak Park Blvd Ste 104
Pismo Beach, CA 93449-3406

Phone

(805) 473-9393

NPI assigned

Mar 30, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Peterson, OD

Title

Owner

Phone

(805) 473-9393

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1238371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1235371782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 OAK PARK BLVD STE 104",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 OAK PARK BLVD STE 104",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493406",
            "telephone_number": "805-473-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH A PETERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-30",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-473-9393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "CA 9884T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "OP9884",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0098840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terra Jones, RN
• Terry L. Kaiura, M.D.
• Sacha Karnofsky
• Katherine Marie Kaufmann-Alderete, R.D.
• Ken P Optometry Corp
• Kidney Dialysis Center of Pismo Beach, LLC
• Lisa Marie Kruitbosch
• Michael Thomas Laird, M.D.
• Matthew Eren Lanson, MD
• Genene Lara

• Eyewear Supplier in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.