Individual
DR. MALLORY CHRISTINE MACRAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4350 CHERRY AVE NE, KEIZER, OR 97303-4855
(503) 393-6060
(503) 393-5096
Mailing address
4350 CHERRY AVE NE, KEIZER, OR 97303-4855
(503) 393-6060
(503) 393-5096
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OR 3408ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500636799
—
OR
Enumeration date
07/14/2011
Last updated
08/19/2011
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