Provider Demographics
NPI:1689738270
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:66434-2232
Mailing Address - Country:US
Mailing Address - Phone:785-742-3021
Mailing Address - Fax:785-742-3061
Practice Address - Street 1:1823 CHASE ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2636
Practice Address - Country:US
Practice Address - Phone:402-245-2017
Practice Address - Fax:402-245-2018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC C MCPEAK OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NED06911OtherGROUP NUMBER
KSDG7240OtherRR MC
NE10024975900Medicaid
KS100357060CMedicaid
NEDG0638OtherRR MC
NED06911OtherNE BCBS
KS4753200001Medicare NSC
NE099339Medicare PIN
NED06911OtherNE BCBS
NE1689738270Medicare PIN
NEDG0638OtherRR MC
NE4753200002Medicare NSC