Provider Demographics
NPI:1750579819
Name:MACDONALD, ELIZABETH KRISTINE (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KRISTINE
Last Name:MACDONALD
Suffix:
Gender:
Credentials:OD
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1145 TOWNPARK AVE STE 1221
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4789
Mailing Address - Country:US
Mailing Address - Phone:407-490-0948
Mailing Address - Fax:407-490-0949
Practice Address - Street 1:1145 TOWNPARK AVE
Practice Address - Street 2:1221
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-961-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist