DR. PETER WILLIAM KISHBAUGH (O.D.) – Optometrist, NPI 1265326342

DR. PETER WILLIAM KISHBAUGH (O.D.) is a healthcare provider. based in Dallas, Texas. specializing in OPTOMETRY. They hold the professional credentials O.D.. They hold a License No. 11420 (TX). The NPI Number for DR. PETER WILLIAM KISHBAUGH (O.D.) is 1265326342

Main info

Male
1 Year Of Experience
Accepts Medicare Assignment
Name
DR. PETER WILLIAM KISHBAUGH (O.D.)
NPI
1265326342
Phone
(214) 220-3937
Address
11442 N CENTRAL EXPY
Enumeration Date
4 June 2025
Last Update Date
6 June 2025

Doctor Profile

Medical School Name
UNIVERSITY OF HOUSTON - COLLEGE OF OPTOMETRY
Secondary Phone
2147540000
Graduation Year
2025 (1 year ago)
PAC ID
5991210510
Group Practice PAC ID
6305828567
Professional Enrollment ID
I20250714001776
Address ID
TX750823579RI3021XRDXX402
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

3,128 OPTOMETRY in TX

Provider Addresses for DR. PETER WILLIAM KISHBAUGH (O.D.)

  • 11442 N CENTRAL EXPY

    DALLAS, TX 752436602

    Phone: (214) 220-3937

    Type: Mailing

  • 3021 E RENNER RD STE 100

    RICHARDSON, TX 750823579

    Phone: (972) 771-2020

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2025-07-14

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
I20250714001776IOptometryTXTBD

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 75243)

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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: 6305828567View full group profile
NameSpecialtyState
O P H T H A L M O L O G YTX
O P H T H A L M O L O G YTX
O P H T H A L M O L O G YTX
O P H T H A L M O L O G YCA
O P T O M E T R YTX
-TX
O P T O M E T R YTX
O P T O M E T R YTX
O P H T H A L M O L O G YTX
O P T O M E T R YTX

Reviews

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Frequently asked questions

What federal number belongs to DR. PETER WILLIAM KISHBAUGH (O.D.)?
The federal identifier for DR. PETER WILLIAM KISHBAUGH (O.D.) is NPI 1265326342.
Does this profile mean DR. PETER WILLIAM KISHBAUGH (O.D.) is currently active?
Yes — DR. PETER WILLIAM KISHBAUGH (O.D.) appears active in the national provider directory.
Does DR. PETER WILLIAM KISHBAUGH (O.D.) list a primary specialty?
If you are matching referrals, note Optometrist for DR. PETER WILLIAM KISHBAUGH (O.D.). Clinical services aligned with this taxonomy classification.
Where does public data place DR. PETER WILLIAM KISHBAUGH (O.D.)?
The snapshot lists Dallas, Texas for DR. PETER WILLIAM KISHBAUGH (O.D.); download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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