Provider Demographics
NPI:1679759856
Name:MARY ANNE PECK, P. C.
Entity Type:Organization
Organization Name:MARY ANNE PECK, P. C.
Other - Org Name:EYECARE AND EYEWEAR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-307-5000
Mailing Address - Street 1:3012 E HEBRON PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4428
Mailing Address - Country:US
Mailing Address - Phone:972-307-5000
Mailing Address - Fax:972-307-7717
Practice Address - Street 1:3012 E HEBRON PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4428
Practice Address - Country:US
Practice Address - Phone:972-307-5000
Practice Address - Fax:972-307-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4513Medicare PIN