Basic Information
| Provider Information | |||||||||
| NPI: | 1326148255 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | A STEPHEN PEYTON JR. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | OPTOMETRIC ASSOCIATES OF LANCASTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 180 GOOD DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176032353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173972020 | ||||||||
| FaxNumber: | 7173990220 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 GOOD DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176032353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173972020 | ||||||||
| FaxNumber: | 7173990220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 02/06/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PEYTON | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | STEPHEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 7173972020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG000144 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2487437 | 01 | PA | AETNA | OTHER | 410049709 | 01 | PA | PALMETTO GBA | OTHER | 4754342002 | 01 | PA | CIGNA | OTHER | 02768500 | 01 | PA | CAPITAL BLUE CROSS | OTHER | PE529728 | 01 | PA | HIGHMARK | OTHER |