Provider Demographics
NPI:1750352688
Name:MCINTOSH, THOMAS C (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:MCINTOSH
Suffix:
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 1:1804 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-752-4380
Mailing Address - Fax:252-747-0419
Practice Address - Street 1:1804 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-752-4380
Practice Address - Fax:252-747-0419
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909578Medicaid
NC09578OtherBCBS
NC1679675581OtherGROUP NPI
NC410017944OtherMEDICARE RAILROAD
NC09578OtherBCBS
NC1679675581OtherGROUP NPI