Healthcare Provider Details

I. General information

NPI: 1932430121
Provider Name (Legal Business Name): NANCY M. MACKOWSKY, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 04/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 FAIR MEADOW LANE SUITE 207
RALEIGH NC
27607-6449
US

IV. Provider business mailing address

4505 FAIR MEADOW LANE SUITE 207
RALEIGH NC
27607-6449
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7600
  • Fax: 919-787-7603
Mailing address:
  • Phone: 919-787-7600
  • Fax: 919-787-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number1571
License Number StateNC

VIII. Authorized Official

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