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Organization
MAVERICK OPTICAL LLC
Active
Organization
MAVERICK OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE PECK LDO (ADMINISTRATIVE ASST)
(606) 564-8794
Entity
Organization
Contact information
Practice address
1937 OLD MAIN ST STE 2, MAYSVILLE, KY 41056-8956
(606) 759-7311
(606) 759-0610
Mailing address
1937 OLD MAIN ST STE 2, MAYSVILLE, KY 41056-8956
(606) 759-7311
(606) 759-0610
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
110718
KY
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332H00000X
Eyewear Supplier
110718
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093159626
NPI
—
01
—
1427041037
NPI
—
05
—
52000155
—
KY
05
—
7100246390
—
KY
Enumeration date
08/24/2017
Last updated
07/21/2022
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