Provider Demographics
NPI:1043266323
Name:MCINTOSH, AMBER (OD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:MCINTOSH
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 1:1255 19TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1459
Mailing Address - Country:US
Mailing Address - Phone:303-293-9311
Mailing Address - Fax:303-293-8028
Practice Address - Street 1:1255 19TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1459
Practice Address - Country:US
Practice Address - Phone:303-293-9311
Practice Address - Fax:303-293-8028
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77013829Medicaid
KY9367302Medicare PIN
KYU68237Medicare UPIN