=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720793086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEAKSIGHT FAMILY EYECARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2023
-----------------------------------------------------
Last Update Date | 01/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2541 SAND PIKE BLVD
-----------------------------------------------------
City | PIGEON FORGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37863-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-428-0959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2541 SAND PIKE BLVD
-----------------------------------------------------
City | PIGEON FORGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37863-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-428-0959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DARION HORNER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 704-778-2961
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------