Active NPI
Irving Peck
- Optician
- Maysville, KY
National Provider Identifier
1063563104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 0396
- Practice address
- 1937 Old Main St
Suite 2
Maysville, KY 41056 - Phone
- (606) 759-7311
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 0396 | KY | Primary |
Addresses
Primary practice location
1937 Old Main St
Suite 2
Maysville, KY 41056
Mailing address
1937 Old Main St
Suite 2
Maysville, KY 41056
Phone (606) 759-7311
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52800976 | Medicaid | KY | |
| 0559408 | Medicaid | OH | |
| 52903960 | Medicaid | KY | |
| 000000077313 | Other | KY | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0396 | KY | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joyce C Peck | Optician | Past | Accepting new patients |
| Maverick Optical LLC | Optician | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optician
- Maysville, KY
- NPI 1982121570
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228867200000",
"number": "1063563104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1937 OLD MAIN ST",
"address_2": "SUITE 2",
"city": "MAYSVILLE",
"state": "KY",
"postal_code": "41056",
"telephone_number": "606-759-7311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1937 OLD MAIN ST",
"address_2": "SUITE 2",
"city": "MAYSVILLE",
"state": "KY",
"postal_code": "41056",
"telephone_number": "606-759-7311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "IRVING",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2008-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "KY",
"license": "0396",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52800976",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0559408",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52903960",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000000077313",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maysville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.