Provider Demographics
NPI:1982869723
Name:MCINTIRE, BELINDA (OD)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N MAY ST APT 6I
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1234
Mailing Address - Country:US
Mailing Address - Phone:312-226-6435
Mailing Address - Fax:
Practice Address - Street 1:3144 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4582
Practice Address - Country:US
Practice Address - Phone:773-880-5400
Practice Address - Fax:773-880-5406
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist