Healthcare Provider Details

I. General information

NPI: 1073000964
Provider Name (Legal Business Name): DANIEL MCINTOSH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18210 LA GRANGE RD STE 110
ORLAND PARK IL
60487-7723
US

IV. Provider business mailing address

18210 LA GRANGE RD STE 110
ORLAND PARK IL
60487-7723
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-1988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9868TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: