Provider Demographics
NPI:1558639062
Name:PEAK VISION CARE, OD PA
Entity Type:Organization
Organization Name:PEAK VISION CARE, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-622-7475
Mailing Address - Street 1:3151 APEX PEAKWAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5709
Mailing Address - Country:US
Mailing Address - Phone:919-622-7475
Mailing Address - Fax:919-887-6955
Practice Address - Street 1:3151 APEX PEAKWAY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5709
Practice Address - Country:US
Practice Address - Phone:919-622-7475
Practice Address - Fax:919-887-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB130Medicare PIN