Provider Demographics
NPI:1588609812
Name:MACKEWIZ, W. LEE (OD)
Entity Type:Individual
Prefix:
First Name:W. LEE
Middle Name:
Last Name:MACKEWIZ
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 1:725 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1236
Mailing Address - Country:US
Mailing Address - Phone:302-834-2020
Mailing Address - Fax:302-325-4000
Practice Address - Street 1:725 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1236
Practice Address - Country:US
Practice Address - Phone:302-834-2020
Practice Address - Fax:302-325-4000
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
165490Medicare PIN
DET64996Medicare UPIN