Healthcare Provider Details

I. General information

NPI: 1477558336
Provider Name (Legal Business Name): AARON D QUNELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W ORCHARD AVE
SELAH WA
98942-1329
US

IV. Provider business mailing address

4015 W CLEARWATER AVE
KENNEWICK WA
99336-5028
US

V. Phone/Fax

Practice location:
  • Phone: 509-697-6177
  • Fax: 509-697-6659
Mailing address:
  • Phone: 509-783-8383
  • Fax: 509-735-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003730
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: