Provider Demographics
NPI:1003902842
Name:JENNIFER QUIRANTE PROFESSIONAL OPTOMETRY CORP
Entity Type:Organization
Organization Name:JENNIFER QUIRANTE PROFESSIONAL OPTOMETRY CORP
Other - Org Name:ROCKAWAY BEACH OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-738-2205
Mailing Address - Street 1:769 HICKEY BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1214
Mailing Address - Country:US
Mailing Address - Phone:650-738-2205
Mailing Address - Fax:650-738-2203
Practice Address - Street 1:769 HICKEY BLVD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1214
Practice Address - Country:US
Practice Address - Phone:650-738-2205
Practice Address - Fax:650-738-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CA15118TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4410900001Medicare NSC
CAZZZ31021ZMedicare PIN