Healthcare Provider Details

I. General information

NPI: 1649436551
Provider Name (Legal Business Name): CRAIG JOHN QUINTAL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 LAPALCO BLVD
MARRERO LA
70072-4338
US

IV. Provider business mailing address

7400 SPRINGLAKE DR
NEW ORLEANS LA
70126-3049
US

V. Phone/Fax

Practice location:
  • Phone: 504-371-9355
  • Fax: 985-652-8371
Mailing address:
  • Phone: 504-957-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1569-601T
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1948-884AT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: