Bert M Peterson Jr., O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000348 Issued in VA

Practice address

1126 E. Lynchburg-Salem TPK
Walmart Vision Center
Bedford, VA 24523-3446

Phone

(540) 586-0111

Fax

(540) 586-0111

NPI assigned

Sep 7, 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 2

Other names 1

• Bert Peterson Professional name

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Farmville Vision Center Inc

  • Optometrist
  • Farmville, VA
  • NPI 1659469567
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1972607323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 823",
            "city": "BEDFORD",
            "state": "VA",
            "postal_code": "245230823",
            "telephone_number": "540-586-0111",
            "fax_number": "540-586-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 E. LYNCHBURG-SALEM TPK",
            "address_2": "WALMART VISION CENTER",
            "city": "BEDFORD",
            "state": "VA",
            "postal_code": "245233446",
            "telephone_number": "540-586-0111",
            "fax_number": "540-586-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BERT",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "92-3065-3",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LUXOTICA MANAGED CARE",
            "identifier": "222702",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BERT",
            "last_name": "PETERSON",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Peakview Dental
• Kevin Penn
• Kristy M. Perkins, COTA/L
• Clay E Peters II, ED.D., L.P.C., N.C.C
• Levi Peters, PT,DPT
• Wesley Fletcher Phillips III, LPC
• Pinnacle Therapies PLLC
• Adam Plaster, D.D.S.
• Laura Pfaff Podyma, LPTA
• Poindexters Res Child Care Facility

• Optometrist in Bedford, VA
• Providers in Bedford, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.