Provider Demographics
NPI:1366523979
Name:MACKEY, SANDRA A (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:MACKEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8925 E 61ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1319
Mailing Address - Country:US
Mailing Address - Phone:918-294-2020
Mailing Address - Fax:918-249-1232
Practice Address - Street 1:8925 E 61ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1319
Practice Address - Country:US
Practice Address - Phone:918-294-2020
Practice Address - Fax:918-249-1232
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK2162OtherEYEMED
OK28502OtherSPECTERA
OK44468682002OtherBC BS OF OKLAHOMA
OK51681OtherDAVIS VISION
OK1750570081OtherNPI GROUP
OK5699190001Medicare NSC
OK51681OtherDAVIS VISION