Provider Demographics
NPI:1053795906
Name:PEACHEY, TAYLER (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLER
Middle Name:
Last Name:PEACHEY
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 1:719 ALMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2313
Mailing Address - Country:US
Mailing Address - Phone:815-932-1116
Mailing Address - Fax:
Practice Address - Street 1:719 ALMAR PKWY
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2313
Practice Address - Country:US
Practice Address - Phone:815-932-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010903152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist