NPIMap

Organization Active NPI

Mark D Peckham OD PC

  • Optometrist
  • Festus, MO
National Provider Identifier
1346419645
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TO2158 Issued in MO
Legal business name
MARK D PECKHAM OD PC
Practice address
600 Westwood
Festus, MO 63028-2061
Phone
(636) 937-4747
Fax
(636) 937-4747
NPI assigned
Feb 21, 2008
Last updated
Mar 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

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

Authorized official

Name
Mark D Peckham, ODNPI 1376539064
Title
Doctor Owner Optometrist
Phone
(636) 927-4747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TO2158 MO Primary

Addresses

Primary practice location

600 Westwood
Festus, MO 63028-2061

Mailing address

600 Westwood
Festus, MO 63028-2061
Phone (636) 937-4747

Other identifiers 1

IdentifierTypeStateIssuer
0367630002OtherMEDICARE PROVIDER NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1346419645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WESTWOOD",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630282061",
            "telephone_number": "636-937-4747",
            "fax_number": "636-937-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WESTWOOD",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630282061",
            "telephone_number": "636-937-4747",
            "fax_number": "636-937-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D PECKHAM OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-21",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "PECKHAM",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "636-927-4747",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "0367630002",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.