William Loftin Petersen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

7031 T Issued in CA

Practice address

34179 Golden Lantern St
Suite 201
Dana Point, CA 92629-2800

Phone

(949) 661-1181

Fax

(949) 661-8892

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

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.

• Matthew Wang OD, Inc

  • Optometrist
  • Irvine, CA
  • NPI 1659301364
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496793600000",
    "number": "1477690105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24692 DEL PRADO",
            "address_2": "STE A",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926293841",
            "telephone_number": "949-661-1181",
            "fax_number": "949-661-8892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34179 GOLDEN LANTERN ST",
            "address_2": "SUITE 201",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926292800",
            "telephone_number": "949-661-1181",
            "fax_number": "949-661-8892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "WILLIAM",
        "middle_name": "LOFTIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2017-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7031 T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jiten P Patel, RPH
• Rajiv J Pathak, M.D.
• Peak Mental Wellness
• Alfred Thomas Pepino, M.D.
• Kendall Perrine, ND
• Kelsey Pham, BCBA
• Mandy Pham
• Stephen E Pituck, M.D.
• Jean Derek Potvin, D.C.
• Bradley B Powell, DC

• Optometrist in Dana Point, CA
• Providers in Dana Point, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.