Provider Demographics
NPI:1295810349
Name:MCINTYRE, DEBRA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 EL CAJON BLVD
Mailing Address - Street 2:WEST COAST EYE CARE ASSOCIATES
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1754
Mailing Address - Country:US
Mailing Address - Phone:619-697-4600
Mailing Address - Fax:619-464-5526
Practice Address - Street 1:6945 EL CAJON BLVD
Practice Address - Street 2:6945 EL CAJON BLVD.
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1754
Practice Address - Country:US
Practice Address - Phone:619-697-4600
Practice Address - Fax:619-464-5526
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3252152W00000X
CAOPT12145TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6805236Medicaid
FL6205623Medicaid
FL6205623Medicaid
CA6805236Medicaid
FLU74823Medicare UPIN