Active NPI
Mackenzie Libengood
- Optometrist
- Waldorf, MD
National Provider Identifier
1730979261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA3086
- Practice address
- 110 Mall Circle
Suite 2001
Waldorf, MD 20602 - Phone
- (301) 705-8444
- Fax
- (301) 705-8448
- NPI assigned
- May 8, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | TA3086 | MD | Primary |
Addresses
Primary practice location
110 Mall Circle
Suite 2001
Waldorf, MD 20602
Mailing address
110 Mall Cir
Suite 2001
Waldorf, MD 20603
Phone (301) 705-8450
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA3086 | MD | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755129600000",
"number": "1730979261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 MALL CIR",
"address_2": "SUITE 2001",
"city": "WALDORF",
"state": "MD",
"postal_code": "20603",
"telephone_number": "301-705-8450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 MALL CIRCLE",
"address_2": "SUITE 2001",
"city": "WALDORF",
"state": "MD",
"postal_code": "20602",
"telephone_number": "301-705-8444",
"fax_number": "301-705-8448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBENGOOD",
"first_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-08",
"last_updated": "2025-08-14",
"certification_date": "2025-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA3086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.