Provider Demographics
NPI:1952375867
Name:MACRI, CANDICE JEANNINE (OD)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:JEANNINE
Last Name:MACRI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-1234
Mailing Address - Country:US
Mailing Address - Phone:724-652-5191
Mailing Address - Fax:724-652-8160
Practice Address - Street 1:1702 W STATE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-1234
Practice Address - Country:US
Practice Address - Phone:724-652-5191
Practice Address - Fax:724-652-8160
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001894785-0001Medicaid
PA40525OtherDAVIS VISION
PA7246525191OtherVISION SERVICE PLAN
PA990301OtherHIGHMARK BCBS
PA0017588OtherDORAL VISION SERVICES
PA102833OtherEYE MED
PA1537987OtherGATEWAY HEALTH PLAN
PAPA 1503OtherVISION BENEFITS OF AMERIC
PA397281OtherNATIONAL VISION ADMINISTR
PA40525OtherDAVIS VISION
PAU92481Medicare UPIN