Organization
CLEVE S MACKENZIE MD A MEDICAL CORPORATION
Active
Other names
Beach Eye Medical Group Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEVE S MACKENZIE MD (OWNER/PHYSICIAN)
(714) 965-9696
Entity
Organization
Contact information
Practice address
19582 BEACH BLVD STE 322, HUNTINGTON BEACH, CA 92648-5924
(714) 965-9696
(714) 965-9797
Mailing address
19582 BEACH BLVD STE 322, HUNTINGTON BEACH, CA 92648-5924
(714) 965-9696
(714) 965-9797
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0085210
—
CA
Enumeration date
08/31/2006
Last updated
03/19/2008
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