Provider Demographics
NPI:1609829894
Name:MCINTYRE, DONALD JAMES (OD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DON
Other - Middle Name:J
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 90107
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-0107
Mailing Address - Country:US
Mailing Address - Phone:907-223-0571
Mailing Address - Fax:907-852-6098
Practice Address - Street 1:579 KINGOSAK STREET
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-852-0273
Practice Address - Fax:907-852-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K162317OtherMEDICARE PTAN
AKOD0143Medicaid
K162317OtherMEDICARE PTAN