Provider Demographics
NPI:1407001241
Name:MACKAY VISION CENTER, LLC
Entity Type:Organization
Organization Name:MACKAY VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:POPE
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-668-2771
Mailing Address - Street 1:207 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6090
Mailing Address - Country:US
Mailing Address - Phone:603-668-2771
Mailing Address - Fax:603-627-3115
Practice Address - Street 1:207 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6090
Practice Address - Country:US
Practice Address - Phone:603-668-2771
Practice Address - Fax:603-627-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0627261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center