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General NPI Number Information
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NPI Number | 1720820004
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Entity Type | Individual
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Provider Name | MACKAYLA ELIZABETH SADILEK OD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 14413 ILLINOIS RD
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City | FORT WAYNE
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State | IN
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Zip | 46814-9610
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Country | US
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Telephone | 260-616-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 14413 ILLINOIS RD STE C
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City | FORT WAYNE
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State | IN
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Zip | 46814-9611
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Country | US
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Telephone | 260-616-0184
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Fax |
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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 | 18004516
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License Number State | IN
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