Healthcare Provider Details

I. General information

NPI: 1760322135
Provider Name (Legal Business Name): MACKENZIE JOYCE WHITLOW OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE JOYCE LEWIS-WHITLOW OD

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 LEESVILLE RD STE 124
RALEIGH NC
27613-4091
US

IV. Provider business mailing address

530 BEAVER RIDGE RD
COLLINSVILLE VA
24078-3081
US

V. Phone/Fax

Practice location:
  • Phone: 919-629-9208
  • Fax: 919-364-6726
Mailing address:
  • Phone: 276-634-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2937
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: