Provider Demographics
NPI:1609096247
Name:PEC HOLDING, PLLC
Entity Type:Organization
Organization Name:PEC HOLDING, PLLC
Other - Org Name:RIVER CITY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-290-6444
Mailing Address - Street 1:10001 TAYLORSVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3116
Mailing Address - Country:US
Mailing Address - Phone:502-290-6444
Mailing Address - Fax:502-290-5645
Practice Address - Street 1:10001 TAYLORSVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3116
Practice Address - Country:US
Practice Address - Phone:502-290-6444
Practice Address - Fax:502-290-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1488DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77903565Medicaid
KYDA9112OtherRR MEDICARE
KY77903565Medicaid
KY7518Medicare PIN