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NPI Code Detail

MEDICARE: DR. RICHARD HENRY MACKOWSKY O.D.

MEDICARE: DR. RICHARD HENRY MACKOWSKY 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
1152W00000XOptometristNC1570NC
2152W00000XOptometrist1570NC

General Provider Information

NPI Number : 1861492381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD HENRY MACKOWSKY O.D.
Provider Business Mailing Address
First Line : 100 CUVASION CT
Second Line :
City : CARY
State : NC
Zip : 27519-6200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5450 NEW HOPE COMMONS DR
Second Line :
City : DURHAM
State : NC
Zip : 27707-9716
Country : US
Telephone Number : 919-489-4653
Fax Number : 919-489-2921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 05/04/2022

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