Provider Demographics
NPI:1265643217
Name:DOWNING-MCPEAK VISION CENTERS
Entity Type:Organization
Organization Name:DOWNING-MCPEAK VISION CENTERS
Other - Org Name:OPTICIAN GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-2181
Mailing Address - Street 1:1507 BRAVO BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3478
Mailing Address - Country:US
Mailing Address - Phone:270-651-2181
Mailing Address - Fax:270-651-2183
Practice Address - Street 1:1507 BRAVO BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3478
Practice Address - Country:US
Practice Address - Phone:270-651-2181
Practice Address - Fax:270-651-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5280071100Medicaid