Healthcare Provider Details

I. General information

NPI: 1508137084
Provider Name (Legal Business Name): MACK EYE CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 BLANDING BLVD
ORANGE PARK FL
32073-2601
US

IV. Provider business mailing address

88 BLANDING BLVD
ORANGE PARK FL
32073-2601
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-9433
  • Fax:
Mailing address:
  • Phone: 904-272-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CINDY NENNIG MACK
Title or Position: OWNER
Credential: OD
Phone: 904-272-9433