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General NPI Number Information
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NPI Number | 1942519145
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Entity Type | Individual
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Provider Name | YVONNE MACINTOSH OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 2909 E HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-4921
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Country | US
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Telephone | 209-552-6754
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Fax | 209-537-4802
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Provider Business Mailing Address
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Address Line | 2909 E HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-4921
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Country | US
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Telephone | 209-552-6754
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Fax | 209-537-4802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | SL1455
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License Number State | CA
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