Kenneth A Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

9884T Issued in CA

Practice address

911 Oak Park Blvd Ste 104
Pismo Beach, CA 93449-3406

Phone

(805) 473-9393

Fax

(805) 473-1974

NPI assigned

Feb 3, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Optometry

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ken P Optometry Corp

  • Optometrist
  • Pismo Beach, CA
  • NPI 1497133011
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202256000000",
    "number": "1871565788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 OAK PARK BLVD STE 104",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493406",
            "telephone_number": "805-473-9393",
            "fax_number": "805-473-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 OAK PARK BLVD STE 104",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493406",
            "telephone_number": "805-473-9393",
            "fax_number": "805-473-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2008-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9884T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0098840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul T Stallman MD Inc
• Irma Del Carmen Perez Martinez, DMD, MS
• Duvy Brian Perez Sanchez
• Perry Patel DDS,Inc
• Andrew Eric Peterson, DC
• Rachael Mary Elizabeth Pharr Larson, P.T.
• Physical Therapy Specialists PTS, Inc.
• Shahriar Pirouz, M.D.
• Pismo Beach Recovery Inc
• Pismo Family Practice Medical Corporation a Ca Prof Medical Corp

• Optometrist in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.

Verify at the official NPI Registry.