Healthcare Provider Details

I. General information

NPI: 1225105117
Provider Name (Legal Business Name): KENNETH H QUIGLEY RDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 N CHESTER AVE
BAKERSFIELD CA
93308-2653
US

IV. Provider business mailing address

2022 N CHESTER AVE
BAKERSFIELD CA
93308-2653
US

V. Phone/Fax

Practice location:
  • Phone: 661-393-2554
  • Fax:
Mailing address:
  • Phone: 661-393-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: