Provider Demographics
NPI:1891147658
Name:MACKELPRANG, ANDREW MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:MACKELPRANG
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 1:220 N MCKEMY AVE
Mailing Address - Street 2:APT 10102
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-835-4472
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:4386 N ORACLE RD
Practice Address - Street 2:# 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1656
Practice Address - Country:US
Practice Address - Phone:520-887-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist