Provider Demographics
NPI:1962652586
Name:MAC DONALD EYE CARE, PLLC
Entity Type:Organization
Organization Name:MAC DONALD EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-527-7000
Mailing Address - Street 1:4238 WILSON BLVD
Mailing Address - Street 2:SUITE 2266
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1823
Mailing Address - Country:US
Mailing Address - Phone:703-527-7000
Mailing Address - Fax:703-527-1000
Practice Address - Street 1:4238 WILSON BLVD
Practice Address - Street 2:SUITE 2266
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1823
Practice Address - Country:US
Practice Address - Phone:703-527-7000
Practice Address - Fax:703-527-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty