Richard Nels Petersen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0PT13129T Issued in CA

Practice address

1745 W Avenue K
Suite a
Lancaster, CA 93534-6502

Phone

(661) 942-8437

Fax

(661) 940-1959

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Antelope Valley Optometric Center, Inc.Group PAC ID 2860437068, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Antelope Valley Optometric Center, Inc.

  • Optometrist
  • Lancaster, CA
  • NPI 1548202864
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229990400000",
    "number": "1407867161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 W AVENUE K",
            "address_2": "SUITE A",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935346502",
            "telephone_number": "661-942-8437",
            "fax_number": "661-940-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 W AVENUE K",
            "address_2": "SUITE A",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935346502",
            "telephone_number": "661-942-8437",
            "fax_number": "661-940-1959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "RICHARD",
        "middle_name": "NELS",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2008-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13129",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "0PT13129T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUE SHIELD",
            "identifier": "SD13129T0",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MESC",
            "identifier": "14156",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Personal Involvement Center, Inc.
• Kumaravel Perumalsamy, M.D.
• Gerald J Peters
• Michael Peters
• Yaron Peters, DPT
• Courtney Peterson
• Destiny Peterson, BSN RN
• Jammie Peterson
• Jeanice Peterson, LEP
• Lise Anne Peterson

• Optometrist in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2008; 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.