Marie Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005688 Issued in MI

Practice address

4281 24TH Ave
Fort Gratiot, MI 48059-3997

Phone

(810) 385-4000

NPI assigned

Jul 24, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Marie Mullally Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Optometry

Education

Ferris State College - College of Optometry, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

P-Cor LLCGroup PAC ID 9931194149, 81 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpeterson@optimeyes.emadirect.md

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.

• Pcor LLC

  • Optometrist
  • Troy, MI
  • NPI 1720033343
  Medicare reassignment Care Compare group NPD
• Pcor, LLC

  • Optometrist
  • Troy, MI
  • NPI 1801122460
  NPD

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1285314237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 BURTCH RD",
            "city": "JEDDO",
            "state": "MI",
            "postal_code": "480322720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4281 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593997",
            "telephone_number": "810-385-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "MULLALLY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Antoinetta Payton-Robinson
• Pcor LLC
• Kimberly Rose Peltz, LMSW
• Jerrie Michele Pemberton, OTR
• Amanda Michelle Penley
• Jennifer Ann Peyerk, P.T.
• Katherine Ann Phelan, M.A., CCC-SLP
• Phillip a. Kohanov O.D. PC
• Physician Healthcare Network, PC
• Bailey Piacentini

• Optometrist in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.