Provider Demographics
NPI:1760557359
Name:MACKEY, ROBERT EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:MACKEY
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:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0880
Mailing Address - Country:US
Mailing Address - Phone:606-528-1143
Mailing Address - Fax:606-523-1145
Practice Address - Street 1:281 N. COMMONWEALTH AVE.
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-0880
Practice Address - Country:US
Practice Address - Phone:606-528-1143
Practice Address - Fax:606-523-1145
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYK712DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0456000001Medicare NSC
KY0778201Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KYT54628Medicare UPIN