Michael S Peterson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP100079 Issued in ID

Practice address

1553 E 3080 S
Salt Lake City, UT 84106-3419

Phone

(801) 879-8721

NPI assigned

Apr 3, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Optometry

Education

Southern California College of Optometry, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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.

• Michael S Peterson, OD, PC

  • Optometrist
  • Salt Lake City, UT
  • NPI 1942437058
  Medicare reassignment NPD Authorized official
• Micah S Mills OD PA

  • Corneal and Contact Management Optometrist
  • Caldwell, ID
  • NPI 1972819365
  NPD (past)
• Total Vision PA

  • Corneal and Contact Management Optometrist
  • Caldwell, ID
  • NPI 1447328463
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1528020955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 W 12300 S",
            "address_2": "STE 111",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209816",
            "telephone_number": "801-679-9177",
            "fax_number": "801-878-7674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 E 3080 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841063419",
            "telephone_number": "801-879-8721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP100079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807202700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010151065",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V6861",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Peterson
• Matthew L Peterson, MD
• McKenzie Peterson
• Megan Jill Peterson
• Michael Peterson, MD
• Micheala Peterson
• Mitchell Taylor Peterson, DPT
• Myranda Peterson, LCSW
• Norma J Peterson, CRNA
• Paula Ruth Peterson, APRN

• Optometrist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.