MEDICARE: DR. ELIZABETH KRISTINE MACDONALD 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	OPC4154	FL

General Provider Information

NPI Number	:	1750579819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH KRISTINE MACDONALD O.D.

Provider Business Mailing Address
First Line	:	1145 TOWNPARK AVE STE 1221
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4789
Country	:	US
Telephone Number	:	407-490-0948
Fax Number	:	407-490-0949

Provider Business Practice Location Address
First Line	:	1145 TOWNPARK AVE
Second Line	:	1221
City	:	LAKE MARY
State	:	FL
Zip	:	32746
Country	:	US
Telephone Number	:	407-961-8191
Fax Number	:

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	05/08/2025

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