Healthcare Provider Details

I. General information

NPI: 1609229277
Provider Name (Legal Business Name): ADRIENNE C QUAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADRIENNE CAITLYN CHAN O.D.

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 S COTTAGE GROVE AVE STE 2-300
CHICAGO IL
60615
US

IV. Provider business mailing address

4822 S COTTAGE GROVE AVE STE 1-300
CHICAGO IL
60615-1614
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax: 312-921-1071
Mailing address:
  • Phone: 312-695-8150
  • Fax: 312-921-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: