MEDICARE: MR. GARY NEIL QUARNBERG 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	CO2351	CO

General Provider Information

NPI Number	:	1831172196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY NEIL QUARNBERG OD

Provider Business Mailing Address
First Line	:	140 N MESA ST
Second Line	:	#D
City	:	FRUITA
State	:	CO
Zip	:	81521-2559
Country	:	US
Telephone Number	:	970-858-6600
Fax Number	:	970-858-6601

Provider Business Practice Location Address
First Line	:	140 N MESA ST
Second Line	:	#D
City	:	FRUITA
State	:	CO
Zip	:	81521-2559
Country	:	US
Telephone Number	:	970-858-6600
Fax Number	:	970-858-6601

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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