Provider Demographics
NPI:1063846921
Name:QUAN, KRYSTLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:
Last Name:QUAN
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 1:3251 20TH AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1915
Mailing Address - Country:US
Mailing Address - Phone:415-564-7785
Mailing Address - Fax:
Practice Address - Street 1:3251 20TH AVE STE 231
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1915
Practice Address - Country:US
Practice Address - Phone:415-564-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist