Active NPI
Jason Trent Peterson, OD
- Optometrist
- Eagle Mountain, UT
National Provider Identifier
1760837066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10382337-9934
- Practice address
- 4408 E Pony Express Pkwy Ste a
Eagle Mountain, UT 84005-5564 - Phone
- (801) 789-3937
- Fax
- (801) 228-2420
- NPI assigned
- Apr 25, 2016
- Last updated
- Jun 28, 2021
- 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 | 10382337-9934 | UT | Primary |
Addresses
Primary practice location
4408 E Pony Express Pkwy Ste a
Eagle Mountain, UT 84005-5564
Mailing address
7732 N Red Oak Rd
Eagle Mountain, UT 84005-4303
Phone (801) 644-3046
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4408 E Pony Express Pkwy
Suite a
Eagle Mountain, UT 84005-5564
Phone (801) 789-3937
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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.
-
- Optometrist
- Eagle Mountain, UT
- NPI 1750791943
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624838400000",
"number": "1760837066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7732 N RED OAK RD",
"city": "EAGLE MOUNTAIN",
"state": "UT",
"postal_code": "840054303",
"telephone_number": "801-644-3046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4408 E PONY EXPRESS PKWY STE A",
"city": "EAGLE MOUNTAIN",
"state": "UT",
"postal_code": "840055564",
"telephone_number": "801-789-3937",
"fax_number": "801-228-2420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JASON",
"middle_name": "TRENT",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-25",
"last_updated": "2021-06-28",
"certification_date": "2021-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "UT",
"license": "10382337-9934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle Mountain, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.