Provider Demographics
NPI:1942519145
Name:MACINTOSH, YVONNE (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:MACINTOSH
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 E HATCH RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-4921
Mailing Address - Country:US
Mailing Address - Phone:209-552-6754
Mailing Address - Fax:209-537-4802
Practice Address - Street 1:2909 E HATCH RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-4921
Practice Address - Country:US
Practice Address - Phone:209-552-6754
Practice Address - Fax:209-537-4802
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL1455156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician