Active NPI
Brandy Peterson, A.B.O.C., N.C.L.E.
- Optician
- Three Rivers, MI
National Provider Identifier
1366833865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 156379
- Practice address
- 18511 South River Rd,
Three Rivers, MI 49093 - Phone
- (734) 657-7543
- NPI assigned
- Feb 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contact Lens Fitter | 156FC0801X | 156379 | MI | |
| Optician | 156FX1800X | 156379 | MI | Primary |
Addresses
Primary practice location
18511 South River Rd,
Three Rivers, MI 49093
Mailing address
18511 South River Rd,
Three Rivers, MI 49093
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 156379 | MI | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423094400000",
"number": "1366833865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18511 SOUTH RIVER RD,",
"city": "THREE RIVERS",
"state": "MI",
"postal_code": "49093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18511 SOUTH RIVER RD,",
"city": "THREE RIVERS",
"state": "MI",
"postal_code": "49093",
"telephone_number": "734-657-7543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "BRANDY",
"name_prefix": "Mrs.",
"credential": "A.B.O.C., N.C.L.E.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-05",
"last_updated": "2015-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "156FC0801X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Contact Lens Fitter",
"state": "MI",
"license": "156379",
"primary": false
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "MI",
"license": "156379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Three Rivers, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.