Provider Demographics
NPI:1043501422
Name:PEACHES, JANIE (HT)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:PEACHES
Suffix:
Gender:F
Credentials:HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:OPTOMETRY DEPT
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-823-2748
Mailing Address - Fax:928-283-2986
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:OPTOMETRY DEPT
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2748
Practice Address - Fax:928-283-2986
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist