L.D Peck,PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

01719 Issued in IA

Legal business name

L.D PECK,PC

Practice address

716 Avenue G
Fort Madison, IA 52627

Phone

(319) 372-2321

Fax

(319) 372-2850

NPI assigned

Jul 13, 2018

Organization subpart

No

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

Authorized official

Name

Taishna Novak

Title

Billing

Phone

(319) 372-2321

Specialties & licenses 1

Addresses

Other names 1

• Fort Madiosn Eye Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• L.D Peck,PC

  • Optometrist
  • Keokuk, IA
  • NPI 1215008164

  O20130117000013

  Same enrollment

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry Don Peck, OD

  • Optometrist
  • Fort Madison, IA
  • NPI 1730174129
  NPD

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1992281984",
    "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",
            "fax_number": "319-372-2850"
        },
        {
            "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": "52627",
            "telephone_number": "319-372-2321",
            "fax_number": "319-372-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L.D PECK,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-13",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "TAISHNA",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "319-372-2321"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Madiosn Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kensington Fort Madison, LLC
• Steve Knight, CRNA
• Samantha Knott, DPT
• Victoria Kogan, MD
• Paul Scot Kunch, D.D.S.
• Vishaun Lawrence, FNP
• Lee County Auditor
• Lee County Auditor
• Lee County Auditor
• Lee County Auditor

• Optometrist in Fort Madison, IA
• Providers in Fort Madison, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.