Provider Demographics
NPI:1437149390
Name:PEEK, ROBERT DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:PEEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3312
Mailing Address - Country:US
Mailing Address - Phone:503-635-7975
Mailing Address - Fax:
Practice Address - Street 1:5045 SW 77TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1812
Practice Address - Country:US
Practice Address - Phone:503-297-1096
Practice Address - Fax:503-296-7240
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1719AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR194712Medicaid
ORT68001Medicare UPIN
OR0000PHDZHMedicare ID - Type Unspecified