Provider Demographics
NPI:1932521580
Name:PEAK VISUAL PERFORMANCE, LLC
Entity Type:Organization
Organization Name:PEAK VISUAL PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-649-1200
Mailing Address - Street 1:1537 S SCATTERFIELD RD
Mailing Address - Street 2:STE B
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5766
Mailing Address - Country:US
Mailing Address - Phone:765-649-1200
Mailing Address - Fax:765-649-4040
Practice Address - Street 1:1607 S SCATTERFIELD RD
Practice Address - Street 2:STE B
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5788
Practice Address - Country:US
Practice Address - Phone:765-649-1200
Practice Address - Fax:765-649-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002944A152W00000X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty