Provider Demographics
NPI:1659626794
Name:PESEK, TROY A (OD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:PESEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29101 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5270
Mailing Address - Country:US
Mailing Address - Phone:440-892-6699
Mailing Address - Fax:
Practice Address - Street 1:29101 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 380
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5270
Practice Address - Country:US
Practice Address - Phone:440-892-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist