Healthcare Provider Details

I. General information

NPI: 1982869723
Provider Name (Legal Business Name): BELINDA MCINTIRE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 12/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 N BROADWAY ST
CHICAGO IL
60657-4582
US

IV. Provider business mailing address

312 N MAY ST APT 6I
CHICAGO IL
60607-1234
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-5400
  • Fax: 773-880-5406
Mailing address:
  • Phone: 312-226-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010121
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: