NPIMap

Organization Active NPI

Fort Madison Lenscrafters

Doing business as Fort Madison Eye Clinic

  • Optometrist
  • Fort Madison, IA
National Provider Identifier
1902093156
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
01719 Issued in IA
Legal business name
FORT MADISON LENSCRAFTERS
Doing business as
Fort Madison Eye Clinic
Practice address
716 Avenue G
Fort Madison, IA 52627-2927
Phone
(319) 372-2321
NPI assigned
Oct 2, 2007
Last updated
Oct 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
Dr. Larry Don Peck, ODNPI 1730174129
Title
Owner/Physician
Phone
(319) 372-2321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 01719 IA Primary

Addresses

Primary practice location

716 Avenue G
Fort Madison, IA 52627-2927

Mailing address

716 Avenue G
Fort Madison, IA 52627-2927
Phone (319) 372-2321

Other identifiers 2

IdentifierTypeStateIssuer
2900894MedicaidIA
24695OtherIABLUE CROSS BLUE SHIELD

Other names 1

  • Fort Madison Eye Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1902093156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 AVENUE G",
            "city": "FORT MADISON",
            "state": "IA",
            "postal_code": "526272927",
            "telephone_number": "319-372-2321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 AVENUE G",
            "city": "FORT MADISON",
            "state": "IA",
            "postal_code": "526272927",
            "telephone_number": "319-372-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MADISON LENSCRAFTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DON",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "319-372-2321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2900894",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "24695",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Madison Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Madison, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.