Healthcare Provider Details

I. General information

NPI: 1801975198
Provider Name (Legal Business Name): STEVEN QUILLIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203-205 SHAW AVENUE
HARRINGTON DE
19952
US

IV. Provider business mailing address

203-205 SHAW AVENUE
HARRINGTON DE
19952
US

V. Phone/Fax

Practice location:
  • Phone: 302-398-8404
  • Fax: 302-398-8818
Mailing address:
  • Phone: 302-398-8404
  • Fax: 302-398-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI30001754
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: