Maverick Optical LLC

Primary specialty

OpticianTaxonomy code 156FX1800X

License

110718 Issued in KY

Legal business name

MAVERICK OPTICAL LLC

Practice address

1937 Old Main St Ste 2
Maysville, KY 41056-8956

Phone

(606) 759-7311

Fax

(606) 759-0610

NPI assigned

Aug 24, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joyce Peck, LDONPI 1427041037

Title

Administrative Asst

Phone

(606) 564-8794

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joyce C Peck

  • Optician
  • Maysville, KY
  • NPI 1427041037
  NPD Authorized official
• Adam Charles Bradley

  • Optician
  • Maysville, KY
  • NPI 1093159626
  NPD
• Irving Peck

  • Optician
  • Maysville, KY
  • NPI 1063563104
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1982121570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1937 OLD MAIN ST STE 2",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410568956",
            "telephone_number": "606-759-7311",
            "fax_number": "606-759-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1937 OLD MAIN ST STE 2",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410568956",
            "telephone_number": "606-759-7311",
            "fax_number": "606-759-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASST",
        "authorized_official_telephone_number": "606-564-8794",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "KY",
            "license": "110718",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "KY",
            "license": "110718",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1093159626",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100246390",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427041037",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52000155",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Co Health Dept. Intermediate School
• Mason County
• Mason County Schools
• Mason Pharmacist Group LLC
• Rebekah Lynn Mattingly, APRN
• Jeffrey Allen Maves, CRNA
• Allen Mayberry, TCM
• Mary Elizabeth Mayhall
• Melinda Galliher Mays, LPCC
• Maysville Diagnostic Center LLC

• Optician in Maysville, KY
• Providers in Maysville, KY by specialty
• Optician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.