Provider Demographics
NPI:1235546094
Name:PECKINPAUGH OCULOPLASTIC SURGERY
Entity Type:Organization
Organization Name:PECKINPAUGH OCULOPLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:PECKINPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-910-2452
Mailing Address - Street 1:2744 FLORAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4116
Mailing Address - Country:US
Mailing Address - Phone:206-910-2452
Mailing Address - Fax:855-802-4392
Practice Address - Street 1:1905 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4061
Practice Address - Country:US
Practice Address - Phone:406-490-9953
Practice Address - Fax:855-802-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty