Provider Demographics
NPI:1306152582
Name:MCKENZIE, JAMIE LYNN (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:BLAUSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8987
Mailing Address - Country:US
Mailing Address - Phone:517-339-4100
Mailing Address - Fax:517-339-4199
Practice Address - Street 1:5700 MARSH RD
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8987
Practice Address - Country:US
Practice Address - Phone:517-339-4100
Practice Address - Fax:517-339-4199
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM30440Medicare PIN