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General NPI Number Information
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NPI Number | 1245478551
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Entity Type | Individual
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Provider Name | PEGGY JO BILPUCH L.D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 705 TAYWOOD RD SUITE-A
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1856
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Country | US
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Telephone | 937-826-2020
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Fax | 937-832-2916
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Provider Business Mailing Address
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Address Line | 705 TAYWOOD RD SUITE-A
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1856
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Country | US
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Telephone | 937-826-2020
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Fax | 937-832-2916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 5702-S
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5702-S
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License Number State | OH
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