Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1171DT | KY |
NPI | 1003017690 |
---|---|
Provider Name | Dr. John D Mackey |
First Address | Lexington, KY 40515-9411 |
Second Address | Lexington, KY 40515-9411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U25923 | (02) | KY |