Healthcare Provider Details

I. General information

NPI: 1801871389
Provider Name (Legal Business Name): MCPEAK VISION PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BRAVO BLVD
GLASGOW KY
42141-3478
US

IV. Provider business mailing address

108 BRAVO BLVD
GLASGOW KY
42141-3478
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-2181
  • Fax: 270-651-2183
Mailing address:
  • Phone: 270-651-2181
  • Fax: 270-651-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: JOSEPH GIRA
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 314-909-0633