Michael Scott Peterson, O.D.

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

0618002288 Issued in VA

Practice address

1201 Broad Rock Blvd
Richmond, VA 23249-0001

Phone

(804) 675-5000

Fax

(804) 675-5908

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Aeg Michigan Professional LLC

  • Optometrist
  • Chesaning, MI
  • NPI 1053032912
  NPD (past)
• Suburban Optometrics Assoc P C

  • Optometrist
  • Livonia, MI
  • NPI 1952518748

  Corneal and Contact Management

  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1437177656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 BROAD ROCK BLVD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232490001",
            "telephone_number": "804-675-5000",
            "fax_number": "804-675-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 BROAD ROCK BLVD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232490001",
            "telephone_number": "804-675-5000",
            "fax_number": "804-675-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "7533",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "MI",
            "license": "4901004024",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "VA",
            "license": "0618002288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4309851",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amity Peterson, DO, PH.D.
• Andrew G Peterson
• Blake Richard Peterson
• Cortney Helen Peterson, FNP-C
• Leslie Ellen Peterson, FNP-C
• Sarah Laine Peterson, PA-C
• Tamara Peterson
• Rajanya Petersson, MD
• Petite Feet LLC
• Maria Elizabeth Petrella, OTD, OTR/L

• Low Vision Rehabilitation Optometrist in Richmond, VA
• Providers in Richmond, VA by specialty
• Low Vision Rehabilitation Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.