Provider Demographics
NPI:1851486625
Name:PECK, DAVID PAUL (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:PECK
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU11719Medicare UPIN