MEDICARE: DR. ROBERT C MACKIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	SD0093020	CA

General Provider Information

NPI Number	:	1043253933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C MACKIN O.D.

Provider Business Mailing Address
First Line	:	406 CANAL ST
Second Line	:
City	:	KING CITY
State	:	CA
Zip	:	93930-3412
Country	:	US
Telephone Number	:	831-385-6400
Fax Number	:	831-385-1015

Provider Business Practice Location Address
First Line	:	406 CANAL ST
Second Line	:
City	:	KING CITY
State	:	CA
Zip	:	93930-3412
Country	:	US
Telephone Number	:	831-385-6400
Fax Number	:	831-385-1015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	06/05/2012

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