Provider Demographics
NPI:1508137084
Name:MACK EYE CARE PA
Entity Type:Organization
Organization Name:MACK EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:NENNIG
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-272-9433
Mailing Address - Street 1:88 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2601
Mailing Address - Country:US
Mailing Address - Phone:904-272-9433
Mailing Address - Fax:
Practice Address - Street 1:88 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2601
Practice Address - Country:US
Practice Address - Phone:904-272-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty