Individual
DR. IVAN MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
630 COMFORT LN, MONROE, NC 28112-6199
(704) 289-5455
(704) 291-2207
Mailing address
630 COMFORT LN, MONROE, NC 28112-6199
(704) 289-5455
(704) 291-2207
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
200401094
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89138MJ
—
NC
Enumeration date
01/18/2006
Last updated
07/07/2010
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