MEDICARE: MACKENZIE JOYCE LEWIS-WHITLOW 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
1	152W00000X	Optometrist	0618003641	VA

General Provider Information

NPI Number	:	1760322135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE JOYCE LEWIS-WHITLOW OD

Provider Business Mailing Address
First Line	:	530 BEAVER RIDGE RD
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-3081
Country	:	US
Telephone Number	:	276-634-7782
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 BEAVER RIDGE RD
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-3081
Country	:	US
Telephone Number	:	276-634-7782
Fax Number	:

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

Provider Enumeration Date	:	03/28/2026
Last Update Date	:	05/28/2026

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