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General NPI Number Information
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NPI Number | 1598889891
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Entity Type | Individual
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Provider Name | QUINT DI GIACOMO O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 112 W HILL AVE
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City | GALLUP
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State | NM
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Zip | 87301-6218
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Country | US
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Telephone | 505-722-2289
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Fax | 505-726-6208
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Provider Business Mailing Address
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Address Line | 10025 E DYNAMITE BLVD STE 115
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-3688
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Country | US
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Telephone | 480-419-7778
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Fax | 480-419-7779
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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 | OP2281
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License Number State | NM
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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 | 01246
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License Number State | AZ
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