Provider Demographics
NPI:1932852308
Name:BLUEGRASS EYEWEAR DBA PEACHY EYEWEAR
Entity Type:Organization
Organization Name:BLUEGRASS EYEWEAR DBA PEACHY EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-663-9317
Mailing Address - Street 1:1525 BLUEGRASS LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7713
Mailing Address - Country:US
Mailing Address - Phone:404-663-9317
Mailing Address - Fax:
Practice Address - Street 1:1525 BLUEGRASS LAKES PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7713
Practice Address - Country:US
Practice Address - Phone:800-220-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUEGRASS EYEWEAR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier