Basic Information
| Provider Information | |||||||||
| NPI: | 1609846625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACHENBACH | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 SPARTA AVE | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737293839 | ||||||||
| FaxNumber: | 9737260651 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | WAYCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122852021 | ||||||||
| FaxNumber: | 9122852558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OA00005411 | NJ | N | Eye and Vision Services Providers | Optometrist | 152WC0802X | OA00005411 | NJ | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | OA00005411 | NJ | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | OPT003079 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.