MEDICARE: NANCY M. MACKOWSKY, OD, PA

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	261QR0400X	Rehabilitation Clinic/Center	1571	NC
2	152W00000X	Optometrist

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	:	1932430121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY M. MACKOWSKY, OD, PA

Provider Business Mailing Address
First Line	:	4505 FAIR MEADOW LANE
Second Line	:	SUITE 207
City	:	RALEIGH
State	:	NC
Zip	:	27607-6449
Country	:	US
Telephone Number	:	919-787-7600
Fax Number	:	919-787-7603

Provider Business Practice Location Address
First Line	:	4505 FAIR MEADOW LANE
Second Line	:	SUITE 207
City	:	RALEIGH
State	:	NC
Zip	:	27607-6449
Country	:	US
Telephone Number	:	919-787-7600
Fax Number	:	919-787-7603

Authorized Official
Title or Position	:	DOCTOR OF OPTOMETRY
Name	:	DR. NANCY M MACKOWSKY
Credential	:	O.D.
Telephone Number	:	919-944-0195

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	04/03/2024

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