DR. DANE M PETERSON (OD) – Optometrist, NPI 1285863530

DR. DANE M PETERSON (OD) is a healthcare provider. based in Maple grove, Minnesota. specializing in OPTOMETRY. They hold the professional credentials OD. They hold a License No. 2738 (CO). The NPI Number for DR. DANE M PETERSON (OD) is 1285863530

Main info

Male
17 Years Of Experience
Accepts Medicare Assignment
Name
DR. DANE M PETERSON (OD)
NPI
1285863530
Phone
(763) 416-7600
Address
12000 Elm Creek Blvd N Ste 100
Enumeration Date
8 July 2009
Last Update Date
17 March 2020

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI ST LOUIS - SCHOOL OF OPTOMETRY
Secondary Phone
7634167600
Graduation Year
2009 (17 years ago)
PAC ID
2769528736
Group Practice PAC ID
2163315045
Professional Enrollment ID
I20130604000320
Address ID
MN554214372MI2601XNEXX401
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience65
Completeness75
Years active:16State licenses:2Digital endpointsOther names

879 OPTOMETRY in MN

Provider Addresses for DR. DANE M PETERSON (OD)

  • 12000 Elm Creek Blvd N Ste 100

    Maple Grove, MN 553697074

    Phone: (763) 416-7600

    Fax: (763) 416-7634

    Type: Location

  • 8501 Golden Valley Rd Ste 100

    Golden Valley, MN 554274472

    Phone: (763) 416-7600

    Fax: (763) 416-7634

    Type: Location

  • 2601 39TH AVE NE STE 1

    ST. ANTHONY, MN 554214372

    Phone: (763) 416-7600

    Fax: (763) 416-7634

    Type: Location

  • Golden Valley Road, Golden Valley, Meander Valley, Tasmania, Australia

    GOLDEN VALLEY, MN 554274488

    Phone: (763) 416-7629

    Fax: (763) 383-4147

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 8 Open Payments records for all available years, with a total value of $246.

Total Amount is formed as General ($246) + Research ($0) + Ownership ($0) = $246.

Last reported payment date: 2024-12-23 • Largest payer in this snapshot: BIOTISSUE HOLDINGS INC. ($201).

Total Amount

$246

General + Research + Ownership

Payments

8

Total payment records

General Amount

$246

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-23

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2013-06-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20130604000320IOptometryMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes474243$0
92014Established patient complete exam of visual system176175$0
92083Exam of visual field with extended testing6358$0
92133Imaging of optic nerve5956$0
99214Established patient office or other outpatient visit, 30-39 minutes5550$0
View full utilization report →

Insurance plans in this area (ZIP 55369)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2163315045View full group profile
NameSpecialtyState
-MN
-MN
O P H T H A L M O L O G YMN
O P H T H A L M O L O G YMN
O P H T H A L M O L O G YMN
O P H T H A L M O L O G YMN
O P H T H A L M O L O G YMN
-MN
O P H T H A L M O L O G YMN
O P T O M E T R YMN

Reviews

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Frequently asked questions

What number should I use to identify DR. DANE M PETERSON (OD) for billing?
Administrative and clinical systems typically use NPI 1285863530 for DR. DANE M PETERSON (OD).
Is DR. DANE M PETERSON (OD)'s NPI status active today?
Active status means DR. DANE M PETERSON (OD)'s NPI record is not deactivated in the public file.
What does the directory say DR. DANE M PETERSON (OD) does?
Insurance directories may phrase it differently, but here DR. DANE M PETERSON (OD) maps to Optometrist. Clinical services aligned with this taxonomy classification.
Is DR. DANE M PETERSON (OD) tied to Maple Grove, Minnesota?
If you are local to Maple Grove, Minnesota, DR. DANE M PETERSON (OD) may be relevant to your search.
Can I export DR. DANE M PETERSON (OD)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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