Provider Demographics
NPI:1043327810
Name:MCINTYRE, WILLIAM CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35184 CENTRAL CITY PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6215
Mailing Address - Country:US
Mailing Address - Phone:734-427-5200
Mailing Address - Fax:734-427-8136
Practice Address - Street 1:655 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1844
Practice Address - Country:US
Practice Address - Phone:248-577-3616
Practice Address - Fax:248-307-9509
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL707675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM30440050Medicare ID - Type UnspecifiedMEDICARE