Gail Ann Petersen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT11093-TPA Issued in CA

Practice address

6615 Riverdale Rd
Riverdale, MD 20737-2908

Phone

(301) 918-0095

Fax

(301) 918-0097

NPI assigned

Dec 29, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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

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.

• Isee Vision Center

  • Optometrist
  • Riverdale, MD
  • NPI 1275117731
  NPD

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1508922717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207372908",
            "telephone_number": "301-918-0095",
            "fax_number": "301-918-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207372908",
            "telephone_number": "301-918-0095",
            "fax_number": "301-918-0097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12100 Wilshire Blvd Ste 1275",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900257143",
            "country_code": "US",
            "telephone_number": "800-485-9196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GAIL",
        "middle_name": "ANN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1874",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT11093-TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0434752",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Riverdale, MD
• Providers in Riverdale, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.