1952375867 NPI number — DR. CANDICE JEANNINE MACRI O.D.

Table of content: ASHLEY JOHNSON (NPI 1912475724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952375867 NPI number — DR. CANDICE JEANNINE MACRI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACRI
Provider First Name:
CANDICE
Provider Middle Name:
JEANNINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952375867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 W STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16101-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-652-5191
Provider Business Mailing Address Fax Number:
724-652-8160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1702 W STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16101-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-652-5191
Provider Business Practice Location Address Fax Number:
724-652-8160
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000557 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001894785-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40525 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7246525191 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 990301 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017588 . This is a "DORAL VISION SERVICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102833 . This is a "EYE MED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1537987 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA 1503 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397281 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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