Provider Demographics
NPI:1114941077
Name:QUINTERO-CHICA, JAVIER G (OD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:G
Last Name:QUINTERO-CHICA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1639
Mailing Address - Country:US
Mailing Address - Phone:845-876-2433
Mailing Address - Fax:
Practice Address - Street 1:19 E MARKET ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1639
Practice Address - Country:US
Practice Address - Phone:845-876-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005366-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1079120001Medicare NSC
NYU40841Medicare UPIN