Provider Demographics
NPI:1568660181
Name:PEEK, JENNIFER L (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:PEEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E BOCKMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-2036
Mailing Address - Country:US
Mailing Address - Phone:931-836-2235
Mailing Address - Fax:
Practice Address - Street 1:126 E BOCKMAN WAY
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2036
Practice Address - Country:US
Practice Address - Phone:931-836-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590039Medicaid
TN3724247Medicaid
TNP00459851OtherRAILROAD MEDICARE
TNP00459851OtherRAILROAD MEDICARE
TN3724247Medicare PIN
TN3590039Medicare PIN