Active NPI
Walter F Peterson, OD
- Optometrist
- Cleveland, TN
National Provider Identifier
1649270703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ODT334
- Practice address
- 2020 Keith St NW
Cleveland, TN 37311-1351 - Phone
- (423) 472-6517
- Fax
- (423) 476-8578
- NPI assigned
- Jul 29, 2005
- Sex
- Male
- Sole proprietor
- No
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 | ODT334 | TN | Primary |
Addresses
Primary practice location
2020 Keith St NW
Cleveland, TN 37311-1351
Mailing address
2020 Keith St NW
Cleveland, TN 37311-1351
Phone (423) 472-6517
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 |
|---|---|---|---|
| ODT334 | TN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720137600000",
"number": "1649270703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 KEITH ST NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373111351",
"telephone_number": "423-472-6517",
"fax_number": "423-476-8578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 KEITH ST NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373111351",
"telephone_number": "423-472-6517",
"fax_number": "423-476-8578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "WALTER",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-29",
"last_updated": "2024-07-05",
"certification_date": "2024-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "ODT334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, TN
- Kristal Ann Peters, BT
- Karen Aguilar Petersen
- Blake Allen Peterson, OD
- Paula L Peterson, PT
- Phyllis Lee Peterson, PT CHT
- Pharmacy Home Care of East Tennessee, Inc (Pharmacy Home Care of East Tennessee)
- Pharmacy Home Delivery LLC (PHD LLC)
- Pharmco (Mouse Creek Pharmacy)
- Samuel Anthony Pharr, P.T.
- Marilyn Liz Phillips-Smeltzer, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.