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General NPI Number Information
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NPI Number | 1396073300
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Entity Type | Organization
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Legal Business Name | MQZ, INC
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 3001 PABLO KISEL BLVD SUITE E
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City | BROWNSVILLE
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State | TX
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Zip | 78526-4278
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Country | US
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Telephone | 956-793-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 PABLO KISEL BLVD STE E
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City | BROWNSVILLE
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State | TX
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Zip | 78526-4280
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Country | US
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Telephone | 956-640-5404
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD ANTHONY MARQUEZ
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Credential | O.D
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Telephone | 956-793-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 6901 TG
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License Number State | TX
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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 | 6901 TG
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License Number State | TX
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