Individual
DR. MARIE MADONNA PECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2169 14TH AVE SE, ALBANY, OR 97322-8510
(541) 967-8730
(541) 926-5465
Mailing address
2169 14TH AVE SE, ALBANY, OR 97322-8510
(541) 967-8730
(541) 926-5465
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2821T
OR
152WC0802X
Corneal and Contact Management Optometrist
2821T
OR
152WP0200X
Pediatric Optometrist
2821T
OR
Other
Enumeration date
01/24/2007
Last updated
05/10/2011
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