DR. KENNETH A PETERSON (NPI# 1871565788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871565788 |
| Entity Type | Individual |
| Full Name | DR. KENNETH A PETERSON |
| Credential | OD |
| Practice Address |
911 Oak Park Blvd Ste 104 Pismo Beach CA 93449-3406 |
| Practice Telephone | 8054739393 |
| Practice Fax Number | 8054731974 |
| Mailing Telephone | 8054739393 |
| Mailing Fax Number | 8054731974 |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2008-02-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 9884T | CA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | SD0098840 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386131324 | Kenneth D Peterson | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2018-04-16 |
| 1912140351 | Kenneth Brian Peterson | Internal Medicine | 8757 E Bell Rd, Scottsdale, AZ 85260-1322 | 2009-04-15 |
| 1164646741 | Kenneth Roy Peterson | Chiropractor | 76 Fort Hill Rd, Groton, CT 06340-4333 | 2007-04-13 |
| 1386768265 | Kenneth Dean Peterson | Chiropractor | 1002 W Elm Ave, Hermiston, OR 97838-2711 | 2007-03-18 |
| 1083706659 | Kenneth B Peterson | Family Medicine | 113 Comanche Rd, Fort Meade, SD 57741-1002 | 2006-09-29 |
| 1053321497 | Kenneth L Peterson | Dentist | 165 Nw 1st Ave, John Day, OR 97845-1101 | 2006-08-08 |
| 1194744896 | Kenneth S Peterson | Nurse Practitioner | 26 Queen St, Worcester, MA 01610 | 2006-07-19 |
| 1144287707 | Kenneth P Peterson | Anesthesiology | 15910 Ventura Blvd, Suite 1502, Encino, CA 91436-2802 | 2006-04-27 |
| Street Address |
911 OAK PARK BLVD STE 104 |
| City | PISMO BEACH |
| State | CA |
| Zip Code | 93449-3406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235371782 | Kenneth A Peterson | Eyewear Supplier (Equipment, not the service) | 911 Oak Park Blvd Ste 104, Pismo Beach, CA 93449-3406 | 2009-03-30 |
| 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 | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821101684 | Michael E. Jacobs | Optometrist | 573 Five Cities Dr, Pismo Beach, CA 93449-3005 | 2006-08-16 |
| 1447230602 | Scott Eric Schachter | Optometrist | 300 James Way, Suite 210, Pismo Beach, CA 93449-2873 | 2006-01-21 |
| 1497133011 | Ken P Optometry Corp | Optometrist | 911 Oak Park Blvd, Suite 104, Pismo Beach, CA 93449-3405 | 2015-05-14 |
| 1588931398 | Dennis Raoul Richardson | Optometrist | 573 Five Cities Dr, Pismo Beach, CA 93449-3005 | 2011-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183428 | Ashley Park | Optometrist | 386 S Green Valley Rd Ste 2, Watsonville, CA 95076-3007 | 2020-10-30 |
| 1053911842 | Michael Guerret | Optometrist | 4130 N Viking Way # 110, Long Beach, CA 90808-1402 | 2020-10-29 |
| 1912506155 | Minati Desai Acharya, O.d., Optometric Corporation | Optometrist | 117 Pelton Center Way, San Leandro, CA 94577-4815 | 2020-10-20 |
| 1740888627 | Jennifer Ngo | Optometrist | 3217 W 153rd St, Gardena, CA 90249-4011 | 2020-10-13 |
| 1649878521 | Jennie Lin | Optometrist | 12914 Cranleigh St, Cerritos, CA 90703-7245 | 2020-10-13 |
| 1962009464 | Jyoti Patel | Optometrist | 1701 Gaffey St., San Pedro, CA 90731 | 2020-10-07 |
| 1114524196 | Kenneth E. Sweeney, O.d., Inc. | Optometrist | 825 Pollard Rd Ste 208, Los Gatos, CA 95032-1435 | 2020-10-03 |
| 1316544364 | Chelsey Kimiko Honma | Optometrist | 3151 Airway Ave Ste M3, Costa Mesa, CA 92626-4626 | 2020-10-02 |
| 1437766920 | Mary Mekhael | Optometrist | 5901 Center Dr Apt 456, Los Angeles, CA 90045-8969 | 2020-09-28 |
| 1013524677 | Jennifer Dang, O.d., A Professional Corporation | Optometrist | 301 S Western Ave Ste 103, Los Angeles, CA 90020-3816 | 2020-09-28 |
| Find all providers with the same taxonomy | ||||
| City | PISMO BEACH |
| Zip Code | 93449 |
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| 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.