MEDICARE: R Q OPTOMETRY

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	4593T	TX

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

General Provider Information

NPI Number	:	1902948383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R Q OPTOMETRY

Provider Business Mailing Address
First Line	:	2777 SHAVER ST STE A
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77502-4625
Country	:	US
Telephone Number	:	713-941-7112
Fax Number	:	713-941-7112

Provider Business Practice Location Address
First Line	:	2777 SHAVER ST STE A
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77502-4625
Country	:	US
Telephone Number	:	713-941-7112
Fax Number	:	713-941-7112

Authorized Official
Title or Position	:	OPTOMETRIST OWNER
Name	:	MR. RAUL QUINTANILLA
Credential	:	OD
Telephone Number	:	713-941-7112

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/10/2016

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Directions to “R Q OPTOMETRY ” Practice Location

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