Walter Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1093699934 Issued in UT

Practice address

250 Red Cliffs Dr
St George, UT 84790-8167

Phone

(435) 674-2020

Fax

(435) 674-3470

NPI assigned

Oct 12, 2006

Last updated

Jul 26, 2012By the provider in NPPES

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 2

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

• Advantage Eye Care , P. C.

  dba Advantage Eye Care

  • Clinic/Center
  • Midvale, UT
  • NPI 1932284130
  NPD (past)
• Standard Optical Co

  • Optometrist
  • Tooele, UT
  • NPI 1477654846
  NPD (past)
• Standard Optical Co

  • Optometrist
  • Taylorsville, UT
  • NPI 1689775041
  NPD (past)
• Standard Optical Co

  • Optometrist
  • Provo, UT
  • NPI 1891882155
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1851480081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 PARKWAY BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841192001",
            "telephone_number": "801-886-2020",
            "fax_number": "801-954-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 RED CLIFFS DR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908167",
            "telephone_number": "435-674-2020",
            "fax_number": "435-674-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "WALTER",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "1093699934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "87017934025001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999000797009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus L Peterson, MD
• Morgan Peterson
• Ryan Thomas Peterson, DPM
• Steffanie Peterson, NP-C
• Tyler Peterson, NP
• Annaleese Petralia
• Gregory Michael Petralia
• Whitney Petrich
• Trevor W Pettingill, MPT
• April Pettit, APRN

• Optometrist in St George, UT
• Providers in St George, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; 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.