Douglas Penisten, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2078 Issued in OK

Practice address

1001 N Grand Ave
Tahlequah, OK 74464-7017

Phone

(918) 458-2109

Fax

(918) 458-2310

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/

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.

• Northeastern State University College of Optometry

  • Optometrist
  • Tahlequah, OK
  • NPI 1437106333
  NPD (past) Authorized official
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Tahlequah, OK
  • NPI 1093722324
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217462400000",
    "number": "1487673489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 N GRAND AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744647017",
            "telephone_number": "918-456-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N GRAND AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744647017",
            "telephone_number": "918-458-2109",
            "fax_number": "918-458-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENISTEN",
        "first_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100760370A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joby Gene Patterson
• Karen Patterson I, PH.D. CCC-SLP/A
• Sarah Anne Pearson, DO
• Fredrick J Pembroke, OD
• Courtney Pendergraft, RDH
• Meghan Pennington, APRN
• People Inc. of Sequoyah Co
• Roberta Lee Perdue
• Dante Perez, MD
• Liliana Perez, PHARMD

• Optometrist in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.