Jay Petersen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

MN1697 Issued in MN

Practice address

N-236 North Garden
Mall of America
Bloomington, MN 55425

Phone

(952) 854-4500

Fax

(952) 858-8525

NPI assigned

Sep 7, 2006

Sex

Male

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Vision World Inc

  • Eyewear Supplier
  • Stillwater, MN
  • NPI 1740365642
  NPD (past)
• Vision World Inc

  • Eyewear Supplier
  • Fergus Falls, MN
  • NPI 1982789533
  NPD (past)
• Visionworks, Inc.

  • Optometrist
  • Austin, MN
  • NPI 1881962173
  NPD (past)
• Visual Edge, Inc

  • Optician
  • Bloomington, MN
  • NPI 1841341898
  NPD (past)
• Visionworks Inc

  • Eyewear Supplier
  • Omaha, NE
  • NPI 1205924792
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801999388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 HAZELTON RD",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354204",
            "telephone_number": "952-926-5300",
            "fax_number": "952-915-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N-236 NORTH GARDEN",
            "address_2": "MALL OF AMERICA",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "55425",
            "telephone_number": "952-854-4500",
            "fax_number": "952-858-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN1697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA/UNITED HEALTH CARE",
            "identifier": "2203100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "23713",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "MN1697",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/MN",
            "identifier": "190P9PE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Atziri Perez-Arthur
• Amy M Perkins, FNP
• Ashley Monet Perry
• Lucy Pershica
• Malinda-Mae Peschong
• Serena Petersen
• Amber Helen Peterson
• Elizabeth M Peterson
• Elysia Peterson, PMHNP
• Jeffrey M Peterson, OD

• Optometrist in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.