Provider Demographics
NPI:1407037690
Name:MACALI EYE CLINIC, PA
Entity Type:Organization
Organization Name:MACALI EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MACALI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-656-3755
Mailing Address - Street 1:1155 S VINELAND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4375
Mailing Address - Country:US
Mailing Address - Phone:407-656-3755
Mailing Address - Fax:407-656-5362
Practice Address - Street 1:1155 S VINELAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4375
Practice Address - Country:US
Practice Address - Phone:407-656-3755
Practice Address - Fax:407-656-5362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP002373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2261Medicare PIN
FLU24969Medicare UPIN
FL4188410001Medicare NSC