Provider Demographics
NPI:1326323478
Name:MACINTYRE, MACKENZIE III (OD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:MACINTYRE
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4600
Mailing Address - Country:US
Mailing Address - Phone:775-358-1317
Mailing Address - Fax:
Practice Address - Street 1:670 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4600
Practice Address - Country:US
Practice Address - Phone:775-358-1317
Practice Address - Fax:775-355-7522
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist