Provider Demographics
NPI:1497087183
Name:MICHAEL MAKEDONSKY OD INC
Entity Type:Organization
Organization Name:MICHAEL MAKEDONSKY OD INC
Other - Org Name:VISION CARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKEDONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-457-7375
Mailing Address - Street 1:6918 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1621
Mailing Address - Country:US
Mailing Address - Phone:415-750-0100
Mailing Address - Fax:415-750-4200
Practice Address - Street 1:6918 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1621
Practice Address - Country:US
Practice Address - Phone:415-750-0100
Practice Address - Fax:415-750-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12463T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6340790001Medicare NSC
CACZ935AMedicare PIN