Healthcare Provider Details

I. General information

NPI: 1750106506
Provider Name (Legal Business Name): SHARON XUEMENG QIU OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: XUEMENG QIU OD, MS

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY AVE W UNIVERSITY OF WATERLOO CONTACT LENS CLINIC
WATERLOO ONTARIO
N2K0H1
CA

IV. Provider business mailing address

506-247 NORTHFIELD DR E
WATERLOO ONTARIO
N2K0H1
CA

V. Phone/Fax

Practice location:
  • Phone: 519-888-4567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: