Provider Demographics
NPI:1689490070
Name:PEC BRIGHTON PLLC
Entity type:Organization
Organization Name:PEC BRIGHTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-502-0255
Mailing Address - Street 1:4111 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7609
Mailing Address - Country:US
Mailing Address - Phone:618-502-0255
Mailing Address - Fax:618-234-6331
Practice Address - Street 1:101 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:IL
Practice Address - Zip Code:62012-1053
Practice Address - Country:US
Practice Address - Phone:618-372-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty