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General NPI Number Information
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NPI Number | 1497087183
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Entity Type | Organization
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Legal Business Name | MICHAEL MAKEDONSKY OD INC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 6918 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-1621
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Country | US
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Telephone | 415-750-0100
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Fax | 415-750-4200
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Provider Business Mailing Address
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Address Line | 6918 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-1621
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Country | US
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Telephone | 415-750-0100
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Fax | 415-750-4200
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL MAKEDONSKY
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Credential | OD
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Telephone | 925-457-7375
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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 | 12463T
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License Number State | CA
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