KENNETH A PETERSON (NPI# 1235371782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235371782 |
| Entity Type | Organization |
| Organization Name | KENNETH A PETERSON |
| Practice Address |
911 Oak Park Blvd Ste 104 Pismo Beach CA 93449-3406 |
| Practice Telephone | 8054739393 |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2009-03-30 |
| Authorized Official Name | DR. KENNETH PETERSON (OWNER) |
| Authorized Official Telephone | 8054739393 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | CA 9884T | CA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | SD0098840 | 05 | |
| CA | MEDICARE ID | OP9884 | 01 |
| Street Address |
911 OAK PARK BLVD STE 104 |
| City | PISMO BEACH |
| State | CA |
| Zip Code | 93449-3406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871565788 | Kenneth A Peterson | Optometrist | 911 Oak Park Blvd Ste 104, Pismo Beach, CA 93449-3406 | 2006-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831688795 | Kristyn Collins | Psychologist | 130 James Way, #150, Pismo Beach, CA 93449 | 2018-05-07 |
| 1245750140 | Judy Burke Morabito | Pedorthist | 801 Dolliver Street, Pismo Beach, CA 93449 | 2017-06-21 |
| 1295274413 | The San Luis Obispo Hearing Center, Inc | Specialist | 901 Oak Park Blvd Suite 202, Pismo Beach, CA 93449 | 2017-02-21 |
| 1649713645 | Sarah Victoria Stroemel | Counselor | 172 Stimson Ave, #3, Pismo Beach, CA 93449 | 2016-11-22 |
| 1497133631 | Byron N Collier | Podiatrist | 911 Oak Park Blvd Ste 106, Pismo Beach, CA 93449 | 2015-05-07 |
| 1982973319 | Mariana Dintyala | Nurse Practitioner | Avery Healthcare Sevices, 230 Coral Ct, Pismo Beach, CA 93449 | 2011-12-13 |
| 1538444575 | Chelsea Hunter | Student in an Organized Health Care Education/Training Program | 448 Foothill Rd, Pismo Beach, CA 93449 | 2011-10-20 |
| 1952621492 | Briana Leigh Schiro | Counselor | 314 El Portal Dr., Suite 100, Pismo Beach, CA 93449 | 2010-06-07 |
| 1134365315 | Robert Lee Hix | Licensed Psychiatric Technician | 201 Five Cities Dr., 123, Pismo Beach, CA 93449 | 2008-12-18 |
| 1689886764 | Active Physical Therapy Inc | Physical Therapist | 1851 Shell Beach Rd, Suite B, Shell Beach, CA 93449 | 2007-05-03 |
| Find all providers in zip 93449 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578698312 | Scott E Schachter Oda Professional Corporation | Eyewear Supplier (Equipment, not the service) | 300 James Way Ste 210, Pismo Beach, CA 93449-2874 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902488 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 300 E Colorado Blvd Ste 128, Pasadena, CA 91101-2267 | 2020-11-02 |
| 1700485562 | Vision Faire Optometry, Inc. A Professional Optometric Corporation | Eyewear Supplier (Equipment, not the service) | 4213 Dale Rd Ste A-2, Modesto, CA 95356-8505 | 2020-10-22 |
| 1154929859 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 5500 W Sunset Blvd, Los Angeles, CA 90028 | 2020-10-14 |
| 1295333029 | Tiger & Lion Inc | Eyewear Supplier (Equipment, not the service) | 1251 S Beach Blvd Ste F, La Habra, CA 90631-6397 | 2020-10-14 |
| 1245866565 | Joshua Adolfo Velasquez | Eyewear Supplier (Equipment, not the service) | 849 N Ridgewood Pl, Los Angeles, CA 90038-4302 | 2020-03-18 |
| 1952948424 | Luvc LLC | Eyewear Supplier (Equipment, not the service) | 2223 Carlton Ave, Pomona, CA 91768-1015 | 2019-12-04 |
| 1568011377 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 6440 E. Pacific Coast Highway, Space B-165, Long Beach, CA 90803 | 2019-09-05 |
| 1184270746 | Nueyes Technologies Inc | Eyewear Supplier (Equipment, not the service) | 120 Newport Center Dr # 232, Newport Beach, CA 92660-6916 | 2019-08-09 |
| 1881248102 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 12182 1/2 Ventura Blvd, Studio City, CA 91604-2517 | 2019-07-25 |
| 1730732363 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 1628 Redwood Hwy Spc D017, Corte Madera, CA 94925-1248 | 2019-07-23 |
| Find all providers with the same taxonomy | ||||
| City | PISMO BEACH |
| Zip Code | 93449 |
Please comment or provide details below to improve the information on KENNETH A PETERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.