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General NPI Number Information
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NPI Number | 1306034830
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Entity Type | Organization
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Legal Business Name | MICHAEL L PECK
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 517 W MAINE AVE
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City | ENID
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State | OK
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Zip | 73701-5542
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Country | US
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Telephone | 580-242-2300
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Fax | 580-233-7370
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Provider Business Mailing Address
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Address Line | 517 W MAINE AVE
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City | ENID
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State | OK
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Zip | 73701-5542
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Country | US
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Telephone | 580-242-2300
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Fax | 580-233-7370
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MICHAEL L PECK
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Credential | O.D.
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Telephone | 580-242-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1058
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1058
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License Number State | OK
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