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Organization
KEN P OPTOMETRY CORP
Active
Organization
KEN P OPTOMETRY CORP
Active
Other names
Dr. Ken Peterson Family Optometry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH A PETERSON O. D. (OWNER/OPTOMETRIST)
(805) 473-9393
Entity
Organization
Contact information
Practice address
911 OAK PARK BLVD, SUITE 104, PISMO BEACH, CA 93449-3405
(805) 473-9393
(805) 473-1974
Mailing address
911 OAK PARK BLVD, SUITE 104, PISMO BEACH, CA 93449-3405
(805) 473-9393
(805) 473-1974
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
05/14/2015
Last updated
05/14/2015
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