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General NPI Number Information
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NPI Number | 1003881574
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Entity Type | Individual
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Provider Name | MARIA QUINTANILLA O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 3701 N MAIN ST STE A
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City | TAYLOR
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State | TX
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Zip | 76574-4975
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Country | US
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Telephone | 512-352-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 2953 DESERT CANDLE DR
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City | ROUND ROCK
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State | TX
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Zip | 78681-2453
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Country | US
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Telephone | 512-352-1600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05312TG
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License Number State | TX
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