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NPI Code Detail

MEDICARE: DANIEL R MCINTOSH & ASSOCIATES OD

MEDICARE: DANIEL R MCINTOSH & ASSOCIATES OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152WS0006XSports Vision Optometrist

General Provider Information

NPI Number : 1417017872
Entity Type Code : Organization
Provider Name (Legal Business Name) : DANIEL R MCINTOSH & ASSOCIATES OD
Provider Business Mailing Address
First Line : 3840 BELFORT RD STE 105
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8208
Country : US
Telephone Number : 904-737-1975
Fax Number :
Provider Business Practice Location Address
First Line : 3840 BELFORT RD STE 105
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8208
Country : US
Telephone Number : 904-737-1975
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DANIEL R MC INTOSH
Credential : OD
Telephone Number : 904-737-1975
Provider Enumeration Date : 12/08/2006
Last Update Date : 06/12/2012

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Directions to “DANIEL R MCINTOSH & ASSOCIATES OD ” Practice Location

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