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General NPI Number Information
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NPI Number | 1255581906
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Entity Type | Organization
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Legal Business Name | QUILLEN OPTICAL
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 421 NORTH MAIN STREET
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City | HARRISONBURG
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State | VA
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Zip | 22802
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Country | US
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Telephone | 540-433-2875
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Fax | 540-433-2875
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Provider Business Mailing Address
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Address Line | 421 NORTH MAIN STREET
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City | HARRISONBURG
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State | VA
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Zip | 22802
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Country | US
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Telephone | 540-433-2875
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Fax | 540-433-2875
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. LOYD PAUL QUILLEN JR.
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Credential |
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Telephone | 540-433-2875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101000503
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License Number State | VA
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