Provider Demographics
NPI:1598980625
Name:DRS PECK & PECK PC
Entity Type:Organization
Organization Name:DRS PECK & PECK PC
Other - Org Name:DRS PECK AND PECK PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-256-6021
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-0789
Mailing Address - Country:US
Mailing Address - Phone:580-256-6021
Mailing Address - Fax:580-254-5301
Practice Address - Street 1:1201 10TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3107
Practice Address - Country:US
Practice Address - Phone:580-256-6021
Practice Address - Fax:580-254-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK442703691001OtherBLUE CROSS BLUE SHEILD OK
OK442703691001OtherBLUE CROSS BLUE SHEILD OK
OK442703691Medicare PIN