Penporn Vongsvivut Reck, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD00049407 Issued in WA

Practice address

345 College St SE Ste C
Lacey, WA 98503-1014

Phone

(360) 456-3200

Fax

(360) 456-3894

NPI assigned

Jul 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Michigan Medical School, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Physicians of Olympia Inc PSGroup PAC ID 8123916962, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.08 of 100Reported as group

Quality

100

Improvement activities

40

Cost

76.93

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: preck@clarus.direct.eyemdemr.com

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.

• Eye Physicians of Olympia Inc PS

  • Ophthalmology Physician
  • Lacey, WA
  • NPI 1821165911
  Medicare reassignment Care Compare group NPD
• Eye Physicians of Olympia Inc PS

  • Corneal and Contact Management Optometrist
  • Dupont, WA
  • NPI 1033427026
  NPD

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1811919871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 COLLEGE ST SE",
            "address_2": "SUITE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031014",
            "telephone_number": "360-456-3200",
            "fax_number": "360-456-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 COLLEGE ST SE STE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031014",
            "telephone_number": "360-456-3200",
            "fax_number": "360-456-3894"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 Lilly Rd NE",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985065030",
            "country_code": "US",
            "telephone_number": "360-456-3200",
            "fax_number": "360-923-4341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "724 Columbia St NW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985011291",
            "country_code": "US",
            "telephone_number": "360-456-3200",
            "fax_number": "360-923-4341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RECK",
        "first_name": "PENPORN",
        "middle_name": "VONGSVIVUT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "WA",
            "license": "MD00049407",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00049407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8511552",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Ray, ARNP
• James F Raymond, M.D.
• Real Heal, PLLC
• Connie Pauline Reandeau, ARNP
• Alicia Reaume
• Stephen D Reck, MD
• Logan Reddy, DPT
• Lauren Reed
• Reflections Therapy, PLLC
• Rowena R Regala, PHYSICAL THERAPIST

• Ophthalmology Physician in Lacey, WA
• Providers in Lacey, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; 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.