Provider Demographics
NPI:1578978201
Name:MCKAY, NATHANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:MCKAY
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 1:1100 2ND PL SE APT 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2556
Mailing Address - Country:US
Mailing Address - Phone:443-302-2108
Mailing Address - Fax:
Practice Address - Street 1:1100 2ND PL SE APT 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2556
Practice Address - Country:US
Practice Address - Phone:814-241-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002929152W00000X
MDTA2485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist