Individual provider Active NPI

Anthony Peterson, OD

  • Optometrist
  • Duncanville, TX
National Provider Identifier
1255474219
Registry record updated Nov 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7032TG Issued in TX
Practice address
150 E Highway 67
Suite 120
Duncanville, TX 75137-4476
Phone
(972) 298-3937
Fax
(972) 298-2170
NPI assigned
Feb 15, 2007
Last updated
Nov 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7032TG TX Primary

Addresses

Primary practice location

150 E Highway 67
Suite 120
Duncanville, TX 75137-4476

Mailing address

150 E Highway 67
Suite 120
Duncanville, TX 75137-4476
Phone (972) 298-3937

Other identifiers 2

IdentifierTypeStateIssuer
269216OtherTXMEDICARE PTAN
196604604OtherTXMEDICAID PROVIDER TPI#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20080430000255 TX Practitioner - Optometry 3375622541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

150 E Hwy 67
Suite 120
Duncanville, TX 75137-4495
Phone (972) 298-3937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7032TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Alp Vision Care Services, PLLC Optometrist CurrentSince Feb 4, 2013 Accepting new patients

Locations

150 E Highway 67
Ste 120
Duncanville, TX 75137
Phone (832) 651-9016

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1255474219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E HIGHWAY 67",
            "address_2": "SUITE 120",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751374476",
            "telephone_number": "972-298-3937",
            "fax_number": "972-298-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E HIGHWAY 67",
            "address_2": "SUITE 120",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751374476",
            "telephone_number": "972-298-3937",
            "fax_number": "972-298-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7032TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "269216",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER TPI#",
            "identifier": "196604604",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duncanville, TX

Sources for this page

Verify at the official NPI Registry.