Provider Demographics
NPI:1649334905
Name:WHITEPLUME, PEGGY JO (OD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:WHITEPLUME
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:JO
Other - Last Name:ROYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9422 TORECCO CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4711
Mailing Address - Country:US
Mailing Address - Phone:307-349-5196
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-4750
Practice Address - Fax:719-526-7853
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002415A152W00000X
IA01905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYU85471Medicare UPIN