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General NPI Number Information
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NPI Number | 1750525820
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Entity Type | Individual
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Provider Name | MARY ELLEN QUAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 2519 NE KENSINGTON CT
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City | ISSAQUAH
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State | WA
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Zip | 98029-3658
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Country | US
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Telephone | 901-277-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 2519 NE KENSINGTON CT
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City | ISSAQUAH
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State | WA
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Zip | 98029-3658
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Country | US
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Telephone |
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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 | 60096396
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License Number State | WA
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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 | 707
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License Number State | HI
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