Provider Demographics
NPI:1578892352
Name:DEBRA L. MCINTYRE, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DEBRA L. MCINTYRE, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-741-2125
Mailing Address - Street 1:306 W EL NORTE PKWY STE L
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1960
Mailing Address - Country:US
Mailing Address - Phone:760-741-2125
Mailing Address - Fax:760-741-2327
Practice Address - Street 1:306 W EL NORTE PKWY STE L
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1960
Practice Address - Country:US
Practice Address - Phone:760-741-2125
Practice Address - Fax:760-741-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP12145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADT383AMedicare PIN