Blake Allen Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODT1031 Issued in TN

Practice address

2020 Keith St NW
Cleveland, TN 37311-1351

Phone

(423) 472-6517

Fax

(423) 476-8578

NPI assigned

Jul 29, 2005

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 TN

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 College of Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Walter F Peterson OD PCGroup PAC ID 6305993452, 3 clinicians

Practice addresses (Care Compare)

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.

• Walter F Peterson OD PC

  • Optometrist
  • Cleveland, TN
  • NPI 1962695916
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1942200159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373111351",
            "telephone_number": "423-472-6517",
            "fax_number": "423-476-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373111351",
            "telephone_number": "423-472-6517",
            "fax_number": "423-476-8578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BLAKE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "ODT1031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Britney R Perez, RBT
• Kristi Runion Perry, RN, IBCLC
• Melissa Pestlin
• Kristal Ann Peters, BT
• Karen Aguilar Petersen
• Paula L Peterson, PT
• Phyllis Lee Peterson, PT CHT
• Walter F Peterson, OD
• Pharmacy Home Care of East Tennessee, Inc
• Pharmacy Home Delivery LLC

• Optometrist in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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.