Wyatt Peterson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3180 Issued in MN

Practice address

10255 Summer PL
Eden Prairie, MN 55347-4719

Phone

(612) 770-7632

NPI assigned

Jul 12, 2009

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

Medicare fee-for-service enrollment

Enrolled in MN

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

Southern California College of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wyattpeterson@direct.eyecare-partners.com

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.

• Clarkson Optometry Inc

  • Optometrist
  • Chanhassen, MN
  • NPI 1982236980
  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Inc

  • Optometrist
  • Elk River, MN
  • NPI 1952992976
  NPD
• Clarkson Optometry, Inc

  • Optometrist
  • Bloomington, MN
  • NPI 1326670324
  NPD
• 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)
• Clarkson Eyecare

  • Optometrist
  • Eureka, MO
  • NPI 1205817731
  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": "1247356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1902035934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10255 SUMMER PL",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474719",
            "telephone_number": "612-770-7632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10255 SUMMER PL",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474719",
            "telephone_number": "612-770-7632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7872 Market Blvd",
            "address_purpose": "LOCATION",
            "city": "Chanhassen",
            "state": "MN",
            "postal_code": "553179440",
            "country_code": "US",
            "telephone_number": "952-934-1424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1731 17th Ave E",
            "address_purpose": "LOCATION",
            "city": "Shakopee",
            "state": "MN",
            "postal_code": "553793372",
            "country_code": "US",
            "telephone_number": "952-445-5600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9721 Lyndale Ave S",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554204232",
            "country_code": "US",
            "telephone_number": "952-884-8338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "WYATT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-12",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Anne Peterson
• Jenna Vivian Peterson
• Madison Peterson
• Nathaniel L Peterson, DPT
• Taylor Peterson
• Cindy J Petrie, RN, WOC
• Deborah K Petron, OTRL
• Samantha Considine Pezon, MD
• Kelsey Mariah Pfaltzgraff
• Tuong Vy Pham, RPH

• Optometrist in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.