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Deactivated NPI 1316937840 Deactivated / Inactive NPI Male Practitioner

Dr. Christopher Glen Petersen , OD

Optometrist • Quincy, WA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Christopher Petersen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 26, 2005
NPI Deactivation Date December 04, 2025
Total Practice Duration ~20 Years of Practice (2005 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Christopher Petersen, OD was a registered Optometrist practicing in Quincy, WA. Throughout an active medical career spanning 20 years, Dr. Petersen provided care at the practice location at 701 2ND AVE SE until profile deactivation on 2025-12-04.

Practice Location & Contact Primary Location

Practice Address

701 2nd Ave Se

Quincy, WA 988481531

Telephone 5097871581
Fax 5097879176
Associated Practice Facility / Clinic
🏢 Kyle M Gillespie O D Ltd Facility NPI 1962728295

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Quincy, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.0 Yrs
State Avg: 20.4 Yrs
Regional Practice Density
2 Specialists

Practicing in Quincy, WA (1692 Statewide)

Telehealth Adoption Rate
50.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License WA OD1175TX

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1649433459

Doctor of Optometry

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
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NPI Profile Deactivated December 04, 2025

Record deactivated on December 04, 2025

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 19, 2025

Optometrist (License #OD1175TX in WA)

NPI Profile Active May 29, 2008

NPI status registered as active in NPPES database

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Updated Practice Location May 29, 2008

Registered at 701 2ND AVE SE, QUINCY, WA 988481531 (Tel: 5097871581)

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Updated Business Mailing Address May 29, 2008

Registered at PO BOX 488, QUINCY, WA 988480488 (Tel: 5097871581)

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Provider Name / Credentials Updated May 29, 2008

Recorded as CHRISTOPHER PETERSEN, OD

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 29, 2008

Optometrist (License #OD1175TX in WA)

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Initial NPI Registration & Enumeration October 26, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1316937840
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 26, 2005
Last Update: May 29, 2008
Deactivation Date: December 04, 2025

Mailing Address

Po Box 488

Quincy, WA 988480488

Phone: 5097871581

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.