Provider Demographics
NPI:1306844923
Name:MACKAY, KIRK A (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:MACKAY
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 1:1901 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1303
Mailing Address - Country:US
Mailing Address - Phone:317-925-2200
Mailing Address - Fax:317-921-6609
Practice Address - Street 1:1901 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1303
Practice Address - Country:US
Practice Address - Phone:317-925-2200
Practice Address - Fax:317-921-6609
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002057A152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
T88594Medicare UPIN
IN273340CMedicare ID - Type Unspecified
IN596360CMedicare ID - Type Unspecified