Provider Demographics
NPI:1598114001
Name:PEC ALTON, LLC
Entity Type:Organization
Organization Name:PEC ALTON, LLC
Other - Org Name:PERFORMANCE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-234-3053
Mailing Address - Street 1:2865 HOMER ADAMS PKWY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4856
Mailing Address - Country:US
Mailing Address - Phone:618-465-1654
Mailing Address - Fax:618-465-8652
Practice Address - Street 1:2865 HOMER ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4856
Practice Address - Country:US
Practice Address - Phone:618-465-1654
Practice Address - Fax:618-465-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty