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NPI Code Detail

MEDICARE: DR. NANCY M. MACKOWSKY OD

MEDICARE:  DR. NANCY M. MACKOWSKY  OD
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
1152W00000XOptometrist1571NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10936COTHERNCBCBS PROV #

General Provider Information

NPI Number : 1285615302
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANCY M. MACKOWSKY OD
Provider Business Mailing Address
First Line : 4505 FAIR MEADOWS LN STE 207
Second Line :
City : RALEIGH
State : NC
Zip : 27607-6449
Country : US
Telephone Number : 919-787-7600
Fax Number : 919-787-7603
Provider Business Practice Location Address
First Line : 4201 LAKE BOONE TRL
Second Line : SUITE 104
City : RALEIGH
State : NC
Zip : 27607-7512
Country : US
Telephone Number : 919-944-0195
Fax Number : 919-944-0085
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 05/04/2022

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Directions to “ DR. NANCY M. MACKOWSKY OD” Practice Location

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