# MAVERICK OPTICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982121570
- **Authorized official:** JOYCE PECK LDO (ADMINISTRATIVE ASST)
- **Authorized official phone:** (606) 564-8794

## Contact information

- **Practice address:** 1937 OLD MAIN ST STE 2, MAYSVILLE, KY 41056-8956
- **Practice address phone:** (606) 759-7311
- **Practice address fax:** (606) 759-0610
- **Mailing address:** 1937 OLD MAIN ST STE 2, MAYSVILLE, KY 41056-8956
- **Mailing address phone:** (606) 759-7311
- **Mailing address fax:** (606) 759-0610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | 110718 | KY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332H00000X | Eyewear Supplier | 110718 | KY | — |

## Other

- **Enumeration date:** 08/24/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1093159626 | NPI | — |
| 01 | — | 1427041037 | NPI | — |
| 05 | — | 52000155 | — | KY |
| 05 | — | 7100246390 | — | KY |