Provider Demographics
NPI:1124181177
Name:MACKAY, DAVID POPE (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:POPE
Last Name:MACKAY
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 1:207 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6090
Mailing Address - Country:US
Mailing Address - Phone:603-668-2771
Mailing Address - Fax:603-627-3115
Practice Address - Street 1:207 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6090
Practice Address - Country:US
Practice Address - Phone:603-668-2771
Practice Address - Fax:603-627-3115
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0627152W00000X, 152WC0802X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE3891Medicare ID - Type Unspecified