Provider Demographics
NPI:1861492381
Name:MACKOWSKY, RICHARD HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HENRY
Last Name:MACKOWSKY
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 1:100 CUVASION CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5450 NEW HOPE COMMONS DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-9716
Practice Address - Country:US
Practice Address - Phone:919-489-4653
Practice Address - Fax:919-489-2921
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1570152W00000X
NC1570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU40612Medicare UPIN
NC2469647DMedicare ID - Type Unspecified