MEDICARE: DR. DAVID CHARLES QUINN O.D.

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	OEG000727	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11228807	OTHER	PA	CAQH
3	201046	OTHER	PA	UPMC

General Provider Information

NPI Number	:	1578558193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHARLES QUINN O.D.

Provider Business Mailing Address
First Line	:	236 W ALLEGHENY RD
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9775
Country	:	US
Telephone Number	:	724-695-3371
Fax Number	:	724-695-3372

Provider Business Practice Location Address
First Line	:	236 W ALLEGHENY RD
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9775
Country	:	US
Telephone Number	:	724-695-3371
Fax Number	:	724-695-3372

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	01/15/2008

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