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General NPI Number Information
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NPI Number | 1124046669
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Entity Type | Individual
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Provider Name | NATALIE JACKIW MACHACEK OD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 18835 TRADITIONS DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-9495
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Country | US
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Telephone | 248-305-1600
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Fax | 248-412-5248
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Provider Business Mailing Address
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Address Line | PO BOX 19060
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City | GREEN BAY
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State | WI
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Zip | 54307-9060
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Country | US
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Telephone | 920-429-7285
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Fax | 920-429-5055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003822
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License Number State | MI
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