KENNETH A PETERSON NPI 1235371782

NPI Information

  • NPI: 1235371782
  • Provider Name: KENNETH A PETERSON
  • Classification: Eyewear Supplier - 332H00000X
  • Entity Type: Organization
  • Address: 911 OAK PARK BLVD STE 104
    PISMO BEACH, CA
    ZIP 93449
  • Phone: (805) 473-9393

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NPI Details

KENNETH A PETERSON is an eyewear supplier in Pismo Beach, CA. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. KENNETH A PETERSON NPI is 1235371782. The provider is registered as an organization entity type.

The provider's business location address is:

911 OAK PARK BLVD STE 104
PISMO BEACH, CA
ZIP 93449-406
Phone: (805) 473-9393

The provider's authorized official is Kenneth Peterson .
The authorized official title is Owner and has the following contact phone number (805) 473-9393.

The enumeration date for this NPI number is 3/30/2009 and was last updated on 3/30/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332H00000XEyewear SupplierCA 9884TCALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1SD0098840MEDICAIDCALIFORNIA
21002290001MEDICARE NSC
3OP9884OTHERCALIFORNIAMEDICARE ID
4U38624MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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