JEFFREY M PETERSON (OD) – Optometrist, NPI 1760454946
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
879 OPTOMETRY in MN
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Provider Addresses for JEFFREY M PETERSON (OD)
Nicollet Av S, East 104th Street, Bloomington, Hennepin County, Minnesota, 55420, United States
MAIL STOP 31500A
BLOOMINGTON, MN 554202824
Phone: (952) 887-6600
Fax: (952) 886-7015
Type: Location
34th Avenue South, Bloomington, Hennepin County, Minnesota, 55425, United States
21110Q
BLOOMINGTON, MN 554251672
Phone: (952) 883-5790
Fax: (952) 883-5395
Type: Mailing
2019 JEFFERSON RD
STE A
NORTHFIELD, MN 550573258
Phone: (507) 645-9202
Fax: (507) 645-9203
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $371.
Total Amount is formed as General ($371) + Research ($0) + Ownership ($0) = $371.
Last reported payment date: 2024-12-03 • Largest payer in this snapshot: Alcon Vision LLC ($251).
Total Amount
$371
General + Research + Ownership
Payments
10
Total payment records
General Amount
$371
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-03
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2011-03-03
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110303000990 | I | Optometry | MN | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 92014 | Established patient complete exam of visual system | 12 | 12 | $0 |
| 92004 | New patient complete exam of visual system | 11 | 11 | $0 |
Insurance plans in this area (ZIP 55420)
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