Provider Demographics
NPI:1023370137
Name:QUICHO, SHIRLEY (OD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:QUICHO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3212
Mailing Address - Country:US
Mailing Address - Phone:408-227-2020
Mailing Address - Fax:206-338-0411
Practice Address - Street 1:590 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3212
Practice Address - Country:US
Practice Address - Phone:408-227-2020
Practice Address - Fax:206-338-0411
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist