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NPI Code Detail

MEDICARE: DR. RANALD MACKENZIE OD

MEDICARE: DR. RANALD MACKENZIE OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristRM002595MI

General Provider Information

NPI Number : 1669412854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANALD MACKENZIE OD
Provider Business Mailing Address
First Line : 32600 GRATIOT AVE
Second Line :
City : ROSEVILLE
State : MI
Zip : 48066-1126
Country : US
Telephone Number : 586-294-0120
Fax Number : 586-294-6322
Provider Business Practice Location Address
First Line : 655 W 13 MILE RD
Second Line :
City : MADISON HTS
State : MI
Zip : 48071-1844
Country : US
Telephone Number : 248-577-3659
Fax Number : 248-588-9320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 03/11/2014

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Directions to “ DR. RANALD MACKENZIE OD” Practice Location

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