Provider Demographics
NPI:1679553150
Name:MACEYKO, RANDALL MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MICHAEL
Last Name:MACEYKO
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 1:915 STATE ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-9457
Mailing Address - Country:US
Mailing Address - Phone:330-482-1000
Mailing Address - Fax:330-482-6000
Practice Address - Street 1:915 STATE ROUTE 46
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-9457
Practice Address - Country:US
Practice Address - Phone:330-482-1000
Practice Address - Fax:330-482-6000
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3550T943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0491918Medicaid
OHMA0520761Medicare ID - Type Unspecified
OH0491918Medicaid
OH0258980001Medicare NSC