Provider Demographics
NPI:1285861864
Name:PEEPERS OPTICAL, LLC
Entity Type:Organization
Organization Name:PEEPERS OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:318-448-4488
Mailing Address - Street 1:4110 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2717
Mailing Address - Country:US
Mailing Address - Phone:318-448-4488
Mailing Address - Fax:318-448-9731
Practice Address - Street 1:1424 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3432
Practice Address - Country:US
Practice Address - Phone:318-448-4488
Practice Address - Fax:318-448-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier