MEDICARE: DR. BENJAMIN LEE MACKEY M.D.

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
1	207W00000X	Ophthalmology Physician	37261	KY
2	152WX0102X	Occupational Vision Optometrist	37261	KY
3	152WC0802X	Corneal and Contact Management Optometrist	37261	KY
4	152WL0500X	Low Vision Rehabilitation Optometrist	37261	KY
5	152WP0200X	Pediatric Optometrist	37261	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730181967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN LEE MACKEY M.D.

Provider Business Mailing Address
First Line	:	281 NORTH COMMONWEALTH AVE.
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701
Country	:	US
Telephone Number	:	606-528-1143
Fax Number	:	606-523-1145

Provider Business Practice Location Address
First Line	:	281 NORTH COMMONWEALTH AVE.
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701
Country	:	US
Telephone Number	:	606-528-1143
Fax Number	:	606-523-1145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/26/2010

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