Organization
FORT MADISON LENSCRAFTERS
Active
Other names
Fort Madison Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY DON PECK OD (OWNER/PHYSICIAN)
(319) 372-2321
Entity
Organization
Contact information
Practice address
716 AVENUE G, FORT MADISON, IA 52627-2927
(319) 372-2321
Mailing address
716 AVENUE G, FORT MADISON, IA 52627-2927
(319) 372-2321
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01719
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24695
BLUE CROSS BLUE SHIELD
IA
05
—
2900894
—
IA
Enumeration date
10/02/2007
Last updated
10/02/2007
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