Provider Demographics
NPI:1366178261
Name:BIGGERS, MACKENZIE RUTH
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RUTH
Last Name:BIGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 BAY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3051
Mailing Address - Country:US
Mailing Address - Phone:518-792-3304
Mailing Address - Fax:
Practice Address - Street 1:357 BAY RD STE 6
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3051
Practice Address - Country:US
Practice Address - Phone:518-792-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0133963152W00000X
NY009753-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist