MEDICARE: EYE MAC OPTOMETRISTS PC

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	152W00000X	Optometrist	TUV-0006542	NY

General Provider Information

NPI Number	:	1750602991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE MAC OPTOMETRISTS PC

Provider Business Mailing Address
First Line	:	5942 DONEGAL MNR
Second Line	:
City	:	CLARENCE CENTER
State	:	NY
Zip	:	14032-9506
Country	:	US
Telephone Number	:	716-480-5425
Fax Number	:	716-631-3860

Provider Business Practice Location Address
First Line	:	8195 SHERIDAN DR
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6002
Country	:	US
Telephone Number	:	716-631-3860
Fax Number	:	716-276-3467

Authorized Official
Title or Position	:	PRACTIONER
Name	:	DR. JASON KELSEY MACLAUGHLIN
Credential	:	OD
Telephone Number	:	716-480-5425

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	05/26/2021

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