# CLEVE S MACKENZIE MD A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beach Eye Medical Group Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699886606
- **Authorized official:** DR. CLEVE S MACKENZIE MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (714) 965-9696

## Contact information

- **Practice address:** 19582 BEACH BLVD STE 322, HUNTINGTON BEACH, CA 92648-5924
- **Practice address phone:** (714) 965-9696
- **Practice address fax:** (714) 965-9797
- **Mailing address:** 19582 BEACH BLVD STE 322, HUNTINGTON BEACH, CA 92648-5924
- **Mailing address phone:** (714) 965-9696
- **Mailing address fax:** (714) 965-9797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 03/19/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0085210 | — | CA |