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General NPI Number Information
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NPI Number | 1215345558
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Entity Type | Individual
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Provider Name | JUNYUE QU O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 509 STILLWELLS CORNER RD STE E5
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-431-9333
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Fax | 732-431-3312
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Provider Business Mailing Address
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Address Line | 509 STILLWELLS CORNER RD STE E5
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City | FREEHOLD
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State | NJ
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Zip | 07728-2965
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Country | US
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Telephone | 732-431-9333
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Fax | 732-431-3312
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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 | OEG002961
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00655900
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License Number State | NJ
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