Organization
MICHAEL L PECK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL L PECK O.D. (OPTOMETRIST)
(580) 242-2300
Entity
Organization
Contact information
Practice address
517 W MAINE AVE, ENID, OK 73701-5542
(580) 242-2300
(580) 233-7370
Mailing address
517 W MAINE AVE, ENID, OK 73701-5542
(580) 242-2300
(580) 233-7370
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1058
OK
332H00000X
Eyewear Supplier
1058
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100765010B
—
OK
01
—
410001137
RAILROAD MEICARE
OK
01
—
730794467004
BLUECROSS BLUESHEILD
—
01
—
800522342
MEDICARE GROUP
OK
01
—
DA7479
RAILROAD MEDICARE GROUP
OK
Enumeration date
10/10/2007
Last updated
08/26/2008
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