MEDICARE: TAL QUIRL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9829776-9934	UT

General Provider Information

NPI Number	:	1306393889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAL QUIRL OD

Provider Business Mailing Address
First Line	:	3988 WASHINGTON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-1826
Country	:	US
Telephone Number	:	16-212-8838
Fax Number	:	801-334-7930

Provider Business Practice Location Address
First Line	:	3988 WASHINGTON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-1826
Country	:	US
Telephone Number	:	801-621-2883
Fax Number	:	801-334-7930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	02/02/2024

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