Provider Demographics
NPI:1720820004
Name:SADILEK, MACKAYLA ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:MACKAYLA
Middle Name:ELIZABETH
Last Name:SADILEK
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:MACKAYLA
Other - Middle Name:ELIZABETH
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14413 ILLINOIS RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9611
Mailing Address - Country:US
Mailing Address - Phone:260-616-0184
Mailing Address - Fax:
Practice Address - Street 1:14413 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9610
Practice Address - Country:US
Practice Address - Phone:260-616-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist