Katlyn Rene Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ATI4633 Issued in OR

Practice address

921 SW 16TH Ave
Portland, OR 97205-1730

Phone

(503) 227-0573

Fax

(503) 227-0509

NPI assigned

Oct 25, 2020

Last updated

Aug 27, 2026By the provider in NPPES

Sex

Female

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

Enrolled in OR

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

University of Missouri St Louis - School of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alberta Eye CareGroup PAC ID 1355575127, 7 clinicians

Urban Eye Gallery, LLCGroup PAC ID 4385885359, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.74 of 100Reported as group

Quality

85.23

Promoting interoperability

100

Improvement activities

40

Cost

77.25

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alberta Eye Care

  dba Cathedral Eye Care

  • Optometrist
  • Portland, OR
  • NPI 1740538388
  Medicare reassignment Care Compare group NPD
• Urban Eye Gallery, LLC

  dba Eye Department

  • Optometrist
  • Portland, OR
  • NPI 1124466545
  Medicare reassignment Care Compare group NPD
• Eye Health Northwest, PC

  • Ophthalmology Physician
  • Milwaukie, OR
  • NPI 1619959731
  Medicare reassignment NPD
• Eye Health Northwest P.C.

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1992397426

  Optometrist

  NPD

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

{
    "created_epoch": "1603584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1538768007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 SW 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051730",
            "telephone_number": "503-227-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 SW 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051730",
            "telephone_number": "503-227-0573",
            "fax_number": "503-227-0509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KATLYN",
        "middle_name": "RENE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-25",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500807355",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jed Russell Peterson, M.D.
• Jenny Lynn Peterson, RN
• Jessica Peterson
• Julie M. Peterson, PMHNP
• Kathryn Peterson
• Katy Celeste Peterson
• Kay Diane Peterson, PMHNP
• Kimberly Nicole Peterson, M.A.
• Leah Peterson, CNM
• Lindsey Louise Peterson, PA-C

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.