Provider Demographics
NPI:1043253933
Name:MACKIN, ROBERT C (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MACKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3412
Mailing Address - Country:US
Mailing Address - Phone:831-385-6400
Mailing Address - Fax:831-385-1015
Practice Address - Street 1:406 CANAL ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3412
Practice Address - Country:US
Practice Address - Phone:831-385-6400
Practice Address - Fax:831-385-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0093020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0692000001Medicare NSC
CAU28475Medicare UPIN