DR. KEN PETERSON FAMILY OPTOMETRY
NPI 1497133011
Optometrist in Pismo Beach, CA

Q: What is Ken P Optometry Corp's NPI number?

The NPI number for Ken P Optometry Corp is 1497133011. It was assigned to this organization in the NPPES registry on May 14, 2015. The provider is doing business as Dr. Ken Peterson Family Optometry.

Q: What is Ken P Optometry Corp's specialty?

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

Active since May 14, 2015

911 OAK PARK BLVD, SUITE 104, PISMO BEACH, CA 93449(805) 473-9393(805) 473-1974 Get Directions Write a Review

NPPES record last updated: May 14, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Dr. Ken Peterson Family Optometry NPPES

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

DR. KEN PETERSON FAMILY OPTOMETRY (NPI 1497133011) is a healthcare organization registered as an optometrist in Pismo Beach, California and active in the NPI registry since May 2015. The organization lists Kenneth A Peterson, Owner/optometrist, as its authorized official.

NPPES Registry Identity

NPI1497133011

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameKEN P OPTOMETRY CORP

Location Address911 OAK PARK BLVD, SUITE 104Pismo Beach, CA 93449-3405

Mailing Address911 Oak Park Blvd, Suite 104Pismo Beach, CA 93449-3405 · (805) 473-9393 · Fax (805) 473-1974

Phone(805) 473-9393

Fax(805) 473-1974

Organization SubpartNo

Authorized OfficialKenneth A PetersonOwner/optometrist · (805) 473-9393

Enumeration DateMay 14, 2015

✔ NPI 1497133011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

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.

911 OAK PARK BLVD, Pismo Beach, CA 93449

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Other Names 1

Doing Business AsDr. Ken Peterson Family Optometry

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 Anthem Blue Cross and Blue Shield, BlueCross BlueShield of Tennessee.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)

Dr. Ken Peterson Family Optometry is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Dr. Ken Peterson Family Optometry, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kenneth Peterson, OD

Optometry

NPI 1871565788

911 OAK PARK BLVD STE 104
Pismo Beach, CA 93449

(805) 473-9393

✔ PECOS✔ Accepts MedicareSame address

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 Ken P Optometry Corp's NPI number?

The NPI number for Ken P Optometry Corp is 1497133011. It was assigned to this organization in the NPPES registry on May 14, 2015. The provider is doing business as Dr. Ken Peterson Family Optometry.

Where is Ken P Optometry Corp located?

Ken P Optometry Corp is located at 911 Oak Park Blvd Suite 104, Pismo Beach, CA 93449. The listed phone number is (805) 473-9393.

What is Ken P Optometry Corp's specialty?

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

Is Ken P Optometry Corp enrolled in Medicare?

Yes. Ken P Optometry Corp is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ken P Optometry Corp?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Ken P Optometry Corp. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Ken P Optometry Corp accept?

Health plans from Anthem Blue Cross and Blue Shield and BlueCross BlueShield of Tennessee list Ken P Optometry Corp 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 Ken P Optometry Corp was last updated on May 14, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.