Provider Demographics
NPI:1609977214
Name:ERIC C MCPEAK OD PA
Entity Type:Organization
Organization Name:ERIC C MCPEAK OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCPEAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-742-3021
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-0336
Mailing Address - Country:US
Mailing Address - Phone:785-742-3021
Mailing Address - Fax:785-742-3061
Practice Address - Street 1:706 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2232
Practice Address - Country:US
Practice Address - Phone:785-742-3021
Practice Address - Fax:785-742-3061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC C MCPEAK OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100357060CMedicaid
KS410049838OtherRR MC
KS650920OtherGROUP NUMBER
KS410049838OtherRR MC
KS=========OtherCOMMERCIAL
KS650920Medicare PIN