Organization
MARK D PECKHAM OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D PECKHAM OD (DOCTOR OWNER OPTOMETRIST)
(636) 927-4747
Entity
Organization
Contact information
Practice address
600 WESTWOOD, FESTUS, MO 63028-2061
(636) 937-4747
(636) 937-4747
Mailing address
600 WESTWOOD, FESTUS, MO 63028-2061
(636) 937-4747
(636) 937-4747
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2158
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0367630002
MEDICARE PROVIDER NUMBER
—
Enumeration date
02/21/2008
Last updated
03/05/2008
Update your record
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