Healthcare Provider Details

I. General information

NPI: 1427041037
Provider Name (Legal Business Name): JOYCE C PECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAVERICK OPTICAL OPTICAL

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 OLD MAIN ST SUITE 2
MAYSVILLE KY
41056-8956
US

IV. Provider business mailing address

PO BOX 54
WASHINGTON KY
41096-0054
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-7311
  • Fax: 606-759-0610
Mailing address:
  • Phone: 606-564-8794
  • Fax: 606-759-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number111468
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: