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General NPI Number Information
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NPI Number | 1902948383
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Entity Type | Organization
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Legal Business Name | R Q OPTOMETRY
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 2777 SHAVER ST STE A
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City | PASADENA
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State | TX
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Zip | 77502-4625
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Country | US
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Telephone | 713-941-7112
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Fax | 713-941-7112
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Provider Business Mailing Address
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Address Line | 2777 SHAVER ST STE A
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City | PASADENA
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State | TX
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Zip | 77502-4625
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Country | US
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Telephone | 713-941-7112
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Fax | 713-941-7112
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | MR. RAUL QUINTANILLA
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Credential | OD
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Telephone | 713-941-7112
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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 | 4593T
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License Number State | TX
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