Provider Demographics
NPI:1003816620
Name:QUAN, VALERIE (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:QUAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 E SECOND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-469-8773
Mailing Address - Fax:909-469-5228
Practice Address - Street 1:795 E SECOND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3899
Practice Address - Fax:909-469-8640
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14069TPG152W00000X
AZ1656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFH339ZMedicare PIN
CACA131954Medicare PIN
AZ392600Medicaid