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DR. KENNETH A PETERSON OD
NPI 1871565788
Optometrist in Pismo Beach, CA

Active since February 03, 2006PECOS EnrolledAccepts Medicare Assignment
0/100
CMS Quality Rating
911 OAK PARK BLVD STE 104, PISMO BEACH, CA 93449(805) 473-9393(805) 473-1974 Get Directions Write a Review

NPPES record last updated: February 6, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Kenneth A Peterson Od NPPES

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

DR. KENNETH A PETERSON OD (NPI 1871565788) is an individual optometrist in Pismo Beach, California, licensed in California (9884T) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1998).

NPPES Registry Identity

NPI1871565788
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. KENNETH A PETERSONCredential: OD
Location Address911 OAK PARK BLVD STE 104Pismo Beach, CA 93449-3406
Mailing Address911 Oak Park Blvd Ste 104Pismo Beach, CA 93449-3406 · (805) 473-9393 · Fax (805) 473-1974
Phone(805) 473-9393
Fax(805) 473-1974
Sole ProprietorYes
Medical School CMSOtherGraduated 1998
Enumeration DateFebruary 3, 2006
Last NPPES UpdateFebruary 6, 2008
✔ NPI 1871565788 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 · 9884T
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 STE 104, Pismo Beach, CA 93449
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Other Identifiers 4

Medicare UPINU38624CA
Medicare NSC1002290001CA
Medicare ID-Type UnspecifiedOP9884
MedicaidSD0098840CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kenneth A Peterson Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6204736283
PECOS Enrollment IDI20040113000703
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 13

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Photography of the retina 92250
Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
428 services388 patients
Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
362 services357 patients
Established patient problem focused exam of visual system 92012
This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
298 services195 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
154 services143 patients
New patient complete exam of visual system 92004
A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
74 services74 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
39 services35 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93449 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$135.73 typical visit price
range $59.84 – $178.89
Typical copayment $33.93 (range $14.96 – $44.72)
Most-billed visit code 99204
Established Patient
$74.24 typical visit price
range $19.70 – $146.55
Typical copayment $18.56 (range $4.92 – $36.63)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

0/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality0
Improvement Activities0

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETH A PETERSON
Eyewear Supplier
911 OAK PARK BLVD STE 104
PISMO BEACH, CA 93449
San Luis Obispo County (805) 473-9393

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 Kenneth Peterson's NPI number?

The NPI number for Kenneth Peterson is 1871565788. It was assigned to this individual provider in the NPPES registry on February 3, 2006.

Where is Kenneth Peterson located?

Kenneth Peterson practices at 911 Oak Park Blvd Ste 104, Pismo Beach, CA 93449. The listed phone number is (805) 473-9393.

What is Kenneth Peterson's specialty?

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

Is Kenneth Peterson enrolled in Medicare?

Yes. Kenneth Peterson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kenneth Peterson accept?

Health plans from Providence Health Plan list Kenneth Peterson 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 Kenneth Peterson was last updated on February 6, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.