Provider Demographics
NPI:1598871048
Name:MCINTOSH, DANIEL R
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 BELFORT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6202
Mailing Address - Country:US
Mailing Address - Phone:904-737-1975
Mailing Address - Fax:904-737-1977
Practice Address - Street 1:3840 BELFORT RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6202
Practice Address - Country:US
Practice Address - Phone:904-737-1975
Practice Address - Fax:904-737-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOPC3198152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL362194OtherCLARITY VISION/OPTICHOICE
FL918655OtherCOLE VISION
FLF103198OtherVBA
FL153450OtherVSP/CIGNA
FL51565OtherDAVIS VISION
FL28377OtherSPECTERA
FL35700OtherAVESIS
FL35700OtherAVESIS