Provider Demographics
NPI:1003097833
Name:CLIFTON L PEAY, M.D.PC
Entity Type:Organization
Organization Name:CLIFTON L PEAY, M.D.PC
Other - Org Name:T/A AMERICAN EYECENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:PEAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-559-7002
Mailing Address - Street 1:8266 ATLEE RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1804
Mailing Address - Country:US
Mailing Address - Phone:804-559-7002
Mailing Address - Fax:804-559-1921
Practice Address - Street 1:8266 ATLEE RD
Practice Address - Street 2:SUITE 224
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1804
Practice Address - Country:US
Practice Address - Phone:804-559-7002
Practice Address - Fax:804-559-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03806Medicare PIN
VAB09489Medicare UPIN