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NPI Code Detail

MEDICARE: DR. CARMEN BAILEY MACKEY O.D.

MEDICARE: DR. CARMEN BAILEY MACKEY 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
1152W00000XOptometrist7261TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17261TGOTHERTXOPTOMETRY LICENSE

General Provider Information

NPI Number : 1144474404
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARMEN BAILEY MACKEY O.D.
Provider Business Mailing Address
First Line : PO BOX 1838
Second Line :
City : CENTER
State : TX
Zip : 75935-1838
Country : US
Telephone Number : 936-598-8501
Fax Number : 936-598-2311
Provider Business Practice Location Address
First Line : 702 LOUISIANA ST
Second Line :
City : CENTER
State : TX
Zip : 75935-3672
Country : US
Telephone Number : 936-598-8501
Fax Number : 936-598-2311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2008
Last Update Date : 01/07/2010

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