Provider Demographics
NPI:1467494989
Name:MAUL, PEGGY HARPSTER (OD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:HARPSTER
Last Name:MAUL
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:112 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2132
Practice Address - Country:US
Practice Address - Phone:419-668-6067
Practice Address - Fax:419-663-6058
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3512 T554152W00000X
OHOPT.003512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479012Medicaid
OH142575OtherEYEMED
OHT48074Medicare UPIN