Peterson, Kenneth A
Peterson, Kenneth A is an sole proprietor health care provider with primary practice located at 911 Oak Park Blvd Ste 104 , Pismo Beach CA 93449-3406. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Peterson, Kenneth A can be contacted via phone (805) 473-9393.Contact Information
Primary practice address
911 Oak Park Blvd Ste 104
Pismo Beach CA 93449-3406
Phone: (805) 473-9393
Fax: (805) 473-1974
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 9884T | California |
Profile Details
| NPI number | 1871565788 |
|---|---|
| LBN Legal business name | Peterson, Kenneth A |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 3rd, 2006 |
| Last updated | Feb 6th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871565788 | NPPES |
| California | MEDICAID | SD0098840 |
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