Individual provider Active NPI

Samantha Kimberly McIntosh, O.D.

  • Optometrist
  • Davie, FL
National Provider Identifier
1770936742
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC5206 Issued in FL
Practice address
3200 S University Dr
Terry Building 1402
Davie, FL 33328-2018
Phone
(954) 262-4200
Fax
(954) 262-3904
NPI assigned
Jul 14, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC5206 FL Primary

Addresses

Primary practice location

3200 S University Dr
Terry Building 1402
Davie, FL 33328-2018

Mailing address

PO Box 290370
Davie, FL 33329-0370
Phone (954) 262-4397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161025002581 FL Practitioner - Optometry 7719265875 Reassigns benefits to 1 organization
I20231019000062 TX Practitioner - Optometry 7719265875 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nova Southeastern University, Inc Optometrist Current Accepting new patients
Total Care PLLC Optometrist CurrentSince Nov 1, 2023 Accepting new patients
Nova Southeastern University Inc. CurrentSince Jul 31, 2016 Accepting new patients
Nova Southeastern University, Inc CurrentSince Jul 31, 2016 Accepting new patients
Nova Southeastern University, Inc Past Accepting new patients

Locations

3200 S University Dr
Bldg 1402
Davie, FL 33328
Phone (954) 262-1402

650 N Andrews Ave
Ft Lauderdale, FL 33311
Phone (954) 463-4213

1750 NE 167th St
North Miami Beach, FL 33162
Phone (305) 949-4000

7888 Gateway Blvd E
Fl 2
El Paso, TX 79915
Phone (915) 300-3484

2680 George Dieter Dr
El Paso, TX 79936
Phone (915) 315-2584

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1770936742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4397",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "TERRY BUILDING 1402",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4200",
            "fax_number": "954-262-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "SAMANTHA",
        "middle_name": "KIMBERLY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.