Provider Demographics
NPI:1932430121
Name:NANCY M. MACKOWSKY, OD, PA
Entity Type:Organization
Organization Name:NANCY M. MACKOWSKY, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-944-0195
Mailing Address - Street 1:4505 FAIR MEADOW LANE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6449
Mailing Address - Country:US
Mailing Address - Phone:919-787-7600
Mailing Address - Fax:919-787-7603
Practice Address - Street 1:4505 FAIR MEADOW LANE
Practice Address - Street 2:SUITE 207
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6449
Practice Address - Country:US
Practice Address - Phone:919-787-7600
Practice Address - Fax:919-787-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
NC1571261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890936CMedicaid
NC890936CMedicaid