Marie Madonna Peck, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2821T Issued in OR

Practice address

2169 14TH Ave SE
Albany, OR 97322-8510

Phone

(541) 967-8730

Fax

(541) 926-5465

NPI assigned

Jan 24, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Madras Vision Source PC

  • Optometrist
  • Madras, OR
  • NPI 1164791414
  Medicare reassignment NPD
• Curtis L. Dix, OD, PC

  • Optometrist
  • Madras, OR
  • NPI 1982889143
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1013062306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2169 14TH AVE SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973228510",
            "telephone_number": "541-967-8730",
            "fax_number": "541-926-5465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2169 14TH AVE SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973228510",
            "telephone_number": "541-967-8730",
            "fax_number": "541-926-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "MARIE",
        "middle_name": "MADONNA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2821T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OR",
            "license": "2821T",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "OR",
            "license": "2821T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick V. Hagerty, DMD, PC
• Rachel Maree Patton, RDN CD IBCLC
• Adam B Paul, MD
• Pci Care Venture I, Inc
• Dora Hazen Pearse
• Charles L. Pederson, M.D., MPH
• Elina Gouw Pederson, RPH
• Erik Pederson
• Jireh Pejana
• Judith Anne Peltier, RN,MPH

• Optometrist in Albany, OR
• Providers in Albany, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.