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KIMBERLY PETERSON, O.D., INC.
NPI 1003120452
Optometrist in Rialto, CA

Active since July 27, 2010
1850 N RIVERSIDE AVE, SUITE 100, RIALTO, CA 92376(909) 421-3030(909) 421-3059 Get Directions Write a Review

NPPES record last updated: July 27, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kimberly Peterson, O.d., Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY PETERSON, O.D., INC. (NPI 1003120452) is a healthcare organization registered as an optometrist in Rialto, California and active in the NPI registry since July 2010. The organization lists Kimberly Peterson, Owner, as its authorized official.

NPPES Registry Identity

NPI1003120452
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameKIMBERLY PETERSON, O.D., INC.
Location Address1850 N RIVERSIDE AVE, SUITE 100Rialto, CA 92376-8071
Mailing Address1850 N Riverside Ave, Suite 100Rialto, CA 92376-8071 · (909) 421-3030 · Fax (909) 421-3059
Phone(909) 421-3030
Fax(909) 421-3059
Organization SubpartNo
Authorized OfficialKimberly PetersonOwner · (909) 421-3030
Enumeration DateJuly 27, 2010
✔ NPI 1003120452 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in CA · 11094T
Definition
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.
1850 N RIVERSIDE AVE, Rialto, CA 92376
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross Blue Shield of Wyoming.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kimberly Peterson, O.d., Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Kimberly Peterson, O.D., Inc., which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Kimberly Peterson, O.D.
Optometry
NPI 1922141175
1850 N RIVERSIDE AVE SUITE 100
Rialto, CA 92376
(909) 421-3030
✔ PECOS✔ Accepts MedicareSame address
Phuong To, O.D.
Optometry
NPI 1215070461
1850 N RIVERSIDE AVE SUITE 100
Rialto, CA 92376
(909) 421-3030
✔ PECOS✔ Accepts MedicareSame address
Marvin Chi
Optometry
NPI 1831750942
2581 CHINO HILLS PKWY STE C
Chino Hills, CA 91709
(909) 393-8378
✔ PECOS✔ Accepts Medicare24 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Peterson, O.D., Inc.'s NPI number?

The NPI number for Kimberly Peterson, O.D., Inc. is 1003120452. It was assigned to this organization in the NPPES registry on July 27, 2010.

Where is Kimberly Peterson, O.D., Inc. located?

Kimberly Peterson, O.D., Inc. is located at 1850 N Riverside Ave Suite 100, Rialto, CA 92376. The listed phone number is (909) 421-3030.

What is Kimberly Peterson, O.D., Inc.'s specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Kimberly Peterson, O.D., Inc. enrolled in Medicare?

Yes. Kimberly Peterson, O.D., Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kimberly Peterson, O.D., Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Optometry, reassign their Medicare billing to Kimberly Peterson, O.D., Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Kimberly Peterson, O.D., Inc. accept?

Health plans from Blue Cross Blue Shield of Wyoming and Blue Cross and Blue Shield of Louisiana list Kimberly Peterson, O.D., Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kimberly Peterson, O.D., Inc. was last updated on July 27, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.