Healthcare Provider Details

I. General information

NPI: 1598871048
Provider Name (Legal Business Name): DANIEL R MCINTOSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 BELFORT RD STE 105
JACKSONVILLE FL
32216-6202
US

IV. Provider business mailing address

3840 BELFORT RD STE 105
JACKSONVILLE FL
32216-6202
US

V. Phone/Fax

Practice location:
  • Phone: 904-737-1975
  • Fax: 904-737-1977
Mailing address:
  • Phone: 904-737-1975
  • Fax: 904-737-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberFLOPC3198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberFLOPC3198
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberFLOPC3198
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberFLOPC3198
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberFLOPC3198
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberFLOPC3198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: