Provider Demographics
NPI:1740330539
Name:MACQUEEN, DONALD ROBIN (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBIN
Last Name:MACQUEEN
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 1:123 KESTER DR
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-9317
Mailing Address - Country:US
Mailing Address - Phone:704-487-7708
Mailing Address - Fax:
Practice Address - Street 1:5960 FAIRVIEW RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0202
Practice Address - Country:US
Practice Address - Phone:888-964-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1311152W00000X
ALS-636152W00000X
NC1262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT65102Medicare UPIN