MEDICARE: ADRIENNE C QUAN 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	046011088	IL

General Provider Information

NPI Number	:	1609229277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE C QUAN O.D.

Provider Business Mailing Address
First Line	:	4822 S COTTAGE GROVE AVE STE 1-300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1614
Country	:	US
Telephone Number	:	312-695-8150
Fax Number	:	312-921-1091

Provider Business Practice Location Address
First Line	:	4822 S COTTAGE GROVE AVE STE 2-300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615
Country	:	US
Telephone Number	:	312-695-8150
Fax Number	:	312-921-1071

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

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	06/16/2026

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