Active NPI
Mark McKenzie, OD
- Optometrist
- McMinnville, OR
National Provider Identifier
1164783718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3488ATI
- Practice address
- 2375 NE Highway 99W
McMinnville, OR 97128-9201 - Phone
- (503) 434-1183
- NPI assigned
- May 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3488ATI | OR | Primary |
Addresses
Primary practice location
2375 NE Highway 99W
McMinnville, OR 97128-9201
Mailing address
1885 NW Alder St
McMinnville, OR 97128-3039
Phone (503) 560-6526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3488ATI | OR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401667200000",
"number": "1164783718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1885 NW ALDER ST",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971283039",
"telephone_number": "503-560-6526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2375 NE HIGHWAY 99W",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971289201",
"telephone_number": "503-434-1183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENZIE",
"first_name": "MARK",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-30",
"last_updated": "2014-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "3488ATI",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.