Healthcare Provider Details

I. General information

NPI: 1407001241
Provider Name (Legal Business Name): MACKAY VISION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MEETINGHOUSE RD
BEDFORD NH
03110-6090
US

IV. Provider business mailing address

207 MEETINGHOUSE RD
BEDFORD NH
03110-6090
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-2771
  • Fax: 603-627-3115
Mailing address:
  • Phone: 603-668-2771
  • Fax: 603-627-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0627
License Number StateNH

VIII. Authorized Official

Name: DR. DAVID POPE MACKAY
Title or Position: MEMBER
Credential: O.D.
Phone: 603-668-2771