Roger L Petersen OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TO2272 Issued in MO

Legal business name

ROGER L PETERSEN OD

Practice address

1817 N Main St
Higginsville, MO 64037-1524

Phone

(660) 584-2956

Fax

(660) 584-3956

NPI assigned

Mar 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roger Leslie Petersen, ODNPI 1679515787

Title

Owner

Phone

(660) 584-2956

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roger Leslie Petersen, OD

  • Optometrist
  • Higginsville, MO
  • NPI 1679515787
  Authorized official Same address or phone

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992829006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 N MAIN ST",
            "city": "HIGGINSVILLE",
            "state": "MO",
            "postal_code": "640371524",
            "telephone_number": "660-584-2956",
            "fax_number": "660-584-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 N MAIN ST",
            "city": "HIGGINSVILLE",
            "state": "MO",
            "postal_code": "640371524",
            "telephone_number": "660-584-2956",
            "fax_number": "660-584-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER L PETERSEN OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "LESLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-584-2956",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sarah Margaret Sims, PHARMD
• Jasbeer Kaur Singh, DDS
• Michelle Ann Sollars-Bosley

• Optometrist in Higginsville, MO
• Providers in Higginsville, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.