| Organization Name: | KENNETH A PETERSON |
| NPI Number: | 1235371782 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH PETERSON (OWNER) |
| Mailing Address: | 911 Oak Park Blvd Ste 104 Pismo Beach |
| State: | CA US |
| Postal Code: | 934493406 |
| Phone Number: | 8054739393 |
| Fax Number: | |
| NPI Enumeration Date: | 03/30/2009 |
| NPI Last Update Date: | 03/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | CA 9884T |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |