Healthcare Provider Details

I. General information

NPI: 1730171174
Provider Name (Legal Business Name): PHILLIP J. MACKINDER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N PARK AVE
WINTER PARK FL
32789-3305
US

IV. Provider business mailing address

1592 SOUTH STATE ROAD 15-A
DELAND FL
32720
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-5156
  • Fax:
Mailing address:
  • Phone: 386-734-2931
  • Fax: 386-734-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: