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General NPI Number Information
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NPI Number | 1922004514
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Entity Type | Individual
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Provider Name | GREGORY M MACIK OD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 101 WILLMAR AVE SW AFFILIATED COMMUNITY MEDICAL CENTERS
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-231-5000
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Fax | 220-231-5067
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Provider Business Mailing Address
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Address Line | 101 WILLMAR AVE SW AFFILIATED COMMUNITY MEDICAL CENTERS
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-231-5000
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Fax | 220-231-5067
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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 | MN2973
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License Number State | MN
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