C S Peters, OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OP0001109 Issued in FL

Practice address

111 N John Sims Pkwy
Valparaiso, FL 32580-1005

Phone

(850) 678-1722

NPI assigned

Oct 3, 2006

Last updated

Dec 2, 2010By 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291248000000",
    "number": "1902990161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N JOHN SIMS PKWY",
            "city": "VALPARAISO",
            "state": "FL",
            "postal_code": "325801005",
            "telephone_number": "850-678-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N JOHN SIMS PKWY",
            "city": "VALPARAISO",
            "state": "FL",
            "postal_code": "325801005",
            "telephone_number": "850-678-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "C S",
        "credential": "OD PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2010-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OP0001109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084488800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Throneberry Mills
• Shawn A. Mitchell, D.M.D.
• Issac B Myers, LMT
• Michael W Nickerson, BCBA
• Emma Ann Petermann, DC
• Leann Terrell Posey, RN
• Laura Jeannette Sandoval
• Donald B Schak Sr., M.D., PA
• Faith Lanette Seck, CNP
• Christy Shields, IBCLC

• Optometrist in Valparaiso, FL
• Providers in Valparaiso, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; 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.