Provider Demographics
NPI:1407978828
Name:PEED, DAVID O (O D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:PEED
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 BRADLEY PARK DR PMB 364
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3620
Mailing Address - Country:US
Mailing Address - Phone:706-660-8880
Mailing Address - Fax:706-660-8882
Practice Address - Street 1:2515 OLD WHITTLESEY RD
Practice Address - Street 2:SUITE H
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3020
Practice Address - Country:US
Practice Address - Phone:706-660-8880
Practice Address - Fax:706-660-8882
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581904380OtherTAX ID
GA00343065JMedicaid
GA581904380OtherTAX ID
GA41ZCCLTMedicare ID - Type UnspecifiedMEDICARE