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General NPI Number Information
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NPI Number | 1598980625
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Entity Type | Organization
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Legal Business Name | DRS PECK & PECK PC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 1201 10TH ST
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City | WOODWARD
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State | OK
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Zip | 73801-3107
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Country | US
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Telephone | 580-256-6021
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Fax | 580-254-5301
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Provider Business Mailing Address
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Address Line | PO BOX 789
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City | WOODWARD
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State | OK
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Zip | 73802-0789
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Country | US
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Telephone | 580-256-6021
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Fax | 580-254-5301
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID PAUL PECK
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Credential | O.D.
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Telephone | 580-256-6021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2022
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License Number State | OK
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