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Individual
TINA MACDONALD
Active
Individual
TINA MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9911T
CA
152WL0500X
Low Vision Rehabilitation Optometrist
OPT9911 TPG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB269766
MEDICARE PTAN WUECI
CA
01
—
WOP9911A
MEDICARE PTAN CPS
CA
Enumeration date
01/30/2007
Last updated
02/10/2017
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