Healthcare Provider Details

I. General information

NPI: 1902648223
Provider Name (Legal Business Name): DARREN ALEXANDER QUINTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N BRAND BLVD STE 200
GLENDALE CA
91202-3638
US

IV. Provider business mailing address

1025 N BRAND BLVD STE 200
GLENDALE CA
91202-3638
US

V. Phone/Fax

Practice location:
  • Phone: 818-583-9933
  • Fax: 818-583-9935
Mailing address:
  • Phone: 818-583-9933
  • Fax: 818-583-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35665-TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT35665-TLG
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT35665-TLG
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT35665-TLG
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOPT35665-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: