Provider Demographics
NPI:1225166895
Name:JOYCE C PECK
Entity Type:Organization
Organization Name:JOYCE C PECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-564-8794
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41096-0054
Mailing Address - Country:US
Mailing Address - Phone:606-564-8794
Mailing Address - Fax:606-759-0610
Practice Address - Street 1:1937 OLD MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8956
Practice Address - Country:US
Practice Address - Phone:606-759-7311
Practice Address - Fax:606-759-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY941156FX1800X
KY079545332H00000X
KY2826372332H00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5290396000Medicaid
KY4295Medicaid
KY4296Medicaid
KY5200016300Medicaid
KY5200015500Medicaid
KY5280097600Medicaid
KY000000537045OtherBCBS
KY7100022560Medicaid
KY5290396000Medicaid