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Individual

PHILLIP J. MACKINDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1592 SOUTH STATE ROAD 15-A, DELAND, FL 32720
(386) 734-2931
(386) 734-2939
Mailing address
1592 SOUTH STATE ROAD 15-A, DELAND, FL 32720
(386) 734-2931
(386) 734-2939

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC3140
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20841
BCBS
FL
01
410040684
MEDICARE RR
FL
01
E0073Z
MEDICARE
FL
Enumeration date
08/22/2005
Last updated
07/30/2014
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