Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 47865699934 | UT |
NPI | 1003057894 |
---|---|
Provider Name | Renee A Mcintosh |
First Address | Draper, UT 84020-7133 |
Second Address | Draper, UT 84020-7133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2009 |
Last Update Date | 26/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U82203 | (02) | UT |