Provider Demographics
NPI:1285615302
Name:MACKOWSKY, NANCY M (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:MACKOWSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4505 FAIR MEADOWS LN STE 207
Mailing Address - Street 2:
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 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-944-0195
Practice Address - Fax:919-944-0085
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0936COtherBCBS PROV #
NC0936COtherBCBS PROV #
NC0936COtherBCBS PROV #
NC890936CMedicaid