Provider Demographics
NPI:1346975620
Name:PEPER, LEXIE MCKENNA (OD)
Entity Type:Individual
Prefix:
First Name:LEXIE
Middle Name:MCKENNA
Last Name:PEPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0550
Mailing Address - Country:US
Mailing Address - Phone:618-942-5465
Mailing Address - Fax:
Practice Address - Street 1:1241 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5005
Practice Address - Country:US
Practice Address - Phone:618-529-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist