Healthcare Provider Details

I. General information

NPI: 1275265209
Provider Name (Legal Business Name): RACHEL SULLIVAN PEYTON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL NICOLE SULLIVAN OD

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 PROFESSIONAL PKWY
TROY MO
63379-2822
US

IV. Provider business mailing address

84 PROFESSIONAL PKWY
TROY MO
63379-2822
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-2020
  • Fax:
Mailing address:
  • Phone: 636-528-2020
  • Fax: 636-528-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2022024193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: