Healthcare Provider Details

I. General information

NPI: 1689490070
Provider Name (Legal Business Name): PEC BRIGHTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAPLE ST
BRIGHTON IL
62012-1053
US

IV. Provider business mailing address

4111 N ILLINOIS ST
SWANSEA IL
62226-7609
US

V. Phone/Fax

Practice location:
  • Phone: 618-372-7000
  • Fax:
Mailing address:
  • Phone: 618-502-0255
  • Fax: 618-234-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: PAM HARK
Title or Position: INSURANCE MANAGER
Credential:
Phone: 618-502-0255