Ken P Optometry Corp

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

KEN P OPTOMETRY CORP

Doing business as

Dr. Ken Peterson Family Optometry

Practice address

911 Oak Park Blvd
Suite 104
Pismo Beach, CA 93449-3405

Phone

(805) 473-9393

Fax

(805) 473-1974

NPI assigned

May 14, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth A Peterson, O. D.NPI 1871565788

Title

Owner/Optometrist

Phone

(805) 473-9393

Specialties & licenses 1

Addresses

Other names 1

• Dr. Ken Peterson Family Optometry Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth A Peterson, OD

  • Optometrist
  • Pismo Beach, CA
  • NPI 1871565788
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431561600000",
    "number": "1497133011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 OAK PARK BLVD",
            "address_2": "SUITE 104",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493405",
            "telephone_number": "805-473-9393",
            "fax_number": "805-473-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 OAK PARK BLVD",
            "address_2": "SUITE 104",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493405",
            "telephone_number": "805-473-9393",
            "fax_number": "805-473-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEN P OPTOMETRY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2015-05-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "805-473-9393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O. D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Ken Peterson Family Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guy Alexander Jones
• Terra Jones, RN
• Terry L. Kaiura, M.D.
• Sacha Karnofsky
• Katherine Marie Kaufmann-Alderete, R.D.
• Kenneth a Peterson
• Kidney Dialysis Center of Pismo Beach, LLC
• Lisa Marie Kruitbosch
• Michael Thomas Laird, M.D.
• Matthew Eren Lanson, MD

• Optometrist in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.