Active NPI
Richard M Peters, OD
- Optometrist
- Wilmington, CA
National Provider Identifier
1518924174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4741T
- Practice address
- 810 N Avalon Blvd
Wilmington, CA 90744-4502 - Phone
- (310) 834-5464
- Fax
- (310) 835-6665
- NPI assigned
- Apr 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4741T | CA | Primary |
Addresses
Primary practice location
810 N Avalon Blvd
Wilmington, CA 90744-4502
Mailing address
810 N Avalon Blvd
Wilmington, CA 90744-4502
Phone (310) 834-5464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0047410 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4741T | CA | MD | Optometrist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237248000000",
"number": "1518924174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 N AVALON BLVD",
"city": "WILMINGTON",
"state": "CA",
"postal_code": "907444502",
"telephone_number": "310-834-5464",
"fax_number": "310-835-6665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 N AVALON BLVD",
"city": "WILMINGTON",
"state": "CA",
"postal_code": "907444502",
"telephone_number": "310-834-5464",
"fax_number": "310-835-6665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "RICHARD",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2009-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "4741T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0047410",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.