Individual provider Active NPI

Mary Anne Peck, O.D.

  • Optometrist
  • Carrollton, TX
National Provider Identifier
1104933118
Registry record updated Mar 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3082TG Issued in TX
Practice address
3012 E. Hebron Parkway
Suite 100
Carrollton, TX 75010-4428
Phone
(972) 307-5000
Fax
(972) 307-7717
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3082TG TX Primary

Addresses

Primary practice location

3012 E. Hebron Parkway
Suite 100
Carrollton, TX 75010-4428

Mailing address

3012 E. Hebron Parkway
Suite 100
Carrollton, TX 75010-4428
Phone (972) 307-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20070412000249 TX Practitioner - Optometry 2961507421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

2703 Richmond Rd
Texarkana, TX 75503-2328
Phone (903) 838-0783

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3082TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist CurrentSince Oct 23, 2019 Accepting new patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Oct 23, 2019 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

3012 E Hebron Pkwy
Ste 100
Carrollton, TX 75010
Phone (972) 307-5000

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206576000000",
    "number": "1104933118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 E. HEBRON PARKWAY",
            "address_2": "SUITE 100",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104428",
            "telephone_number": "972-307-5000",
            "fax_number": "972-307-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 E. HEBRON PARKWAY",
            "address_2": "SUITE 100",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104428",
            "telephone_number": "972-307-5000",
            "fax_number": "972-307-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2008-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3082TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

Verify at the official NPI Registry.