Provider Demographics
NPI:1942351648
Name:MACEY, MICHAEL JOHN (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:MACEY
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 1:423 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-9597
Mailing Address - Country:US
Mailing Address - Phone:724-850-8050
Mailing Address - Fax:724-532-3728
Practice Address - Street 1:1933 DAILEY AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-3087
Practice Address - Country:US
Practice Address - Phone:724-532-3727
Practice Address - Fax:724-532-3728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA199862OtherBLUECROSSBLUESHIELD
PA1804008Medicaid
PA49912OtherDAVIS
PA918348OtherEYEMED
PA0017406OtherDORAL
PA0017406OtherDORAL
PAU72414Medicare UPIN