Individual
DR. JEFFREY LEE MACKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
20 SOUTH BROADWAY, PELICAN RAPIDS, MN 56572
(218) 863-7061
(218) 863-7062
Mailing address
42005 FAWN OAKS ESTATES, DENT, MN 56528
(218) 758-6225
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2365
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
541525000
—
MN
Enumeration date
07/27/2006
Last updated
01/11/2008
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