Provider Demographics
NPI:1275265209
Name:PEYTON, RACHEL SULLIVAN (OD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SULLIVAN
Last Name:PEYTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:NICOLE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:84 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2822
Mailing Address - Country:US
Mailing Address - Phone:636-528-2020
Mailing Address - Fax:636-528-7361
Practice Address - Street 1:84 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2822
Practice Address - Country:US
Practice Address - Phone:636-528-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022024193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist