Healthcare Provider Details

I. General information

NPI: 1003908849
Provider Name (Legal Business Name): PECK OPTICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LONGVIEW DRIVE
LEXINGTON KY
40503-1817
US

IV. Provider business mailing address

370 LONGVIEW DRIVE
LEXINGTON KY
40503-1817
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-2573
  • Fax: 859-276-2574
Mailing address:
  • Phone: 859-276-2573
  • Fax: 859-276-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number314
License Number StateKY

VIII. Authorized Official

Name: MR. DENNIS PAUL PECK
Title or Position: PRESIDENT OPTICIAN
Credential: OPTICIAN
Phone: 859-276-2573