Healthcare Provider Details

I. General information

NPI: 1023370137
Provider Name (Legal Business Name): SHIRLEY QUICHO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 BLOSSOM HILL RD
SAN JOSE CA
95123-3212
US

IV. Provider business mailing address

590 BLOSSOM HILL RD
SAN JOSE CA
95123-3212
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-2020
  • Fax: 206-338-0411
Mailing address:
  • Phone: 408-227-2020
  • Fax: 206-338-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: