Roger Leslie Petersen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TO2272 Issued in MO

Practice address

1817 Main St
Higginsville, MO 64037-1524

Phone

(660) 584-2956

Fax

(660) 584-3956

NPI assigned

Jun 12, 2006

Last updated

Oct 29, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Roger L Petersen OD

  • Optometrist
  • Higginsville, MO
  • NPI 1992829006
  Authorized official Same address or phone

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477699200000",
    "number": "1679515787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 MAIN ST",
            "city": "HIGGINSVILLE",
            "state": "MO",
            "postal_code": "640371524",
            "telephone_number": "660-584-2956",
            "fax_number": "660-584-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 MAIN ST",
            "city": "HIGGINSVILLE",
            "state": "MO",
            "postal_code": "640371524",
            "telephone_number": "660-584-2956",
            "fax_number": "660-584-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ROGER",
        "middle_name": "LESLIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2016-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodney Lance McCaslin, PT
• Midwest Division - LRHC LLC (Higginsville Medical Clinic)
• Sara E. Nicolaus, PHARM.D.
• Nadia Parsan, MD
• Andrew Michael Penner, PLPC
• Physical Therapy of Higginsville
• Plattner Dental Associates, LLC (Plattner Dentistry Family & Cosmetic)
• Progressive Alternative Living, Inc
• Progressive Alternative Living, Inc.
• Mary E. Pugh, LCSW

• Optometrist in Higginsville, MO
• Providers in Higginsville, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.