Healthcare Provider Details

I. General information

NPI: 1346213154
Provider Name (Legal Business Name): ROBERT H. QUICK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 HWY 14 N SUITE 3
CEDAR CREST NM
87008-9407
US

IV. Provider business mailing address

PO BOX 1640
CEDAR CREST NM
87008-1640
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-0300
  • Fax: 505-286-7754
Mailing address:
  • Phone: 505-286-0300
  • Fax: 505-286-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number299
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: