Provider Demographics
NPI:1225073414
Name:QUINLIVAN, PAIGE ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:QUINLIVAN
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 1:107 WAGON WHEEL TRL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2404
Mailing Address - Country:US
Mailing Address - Phone:512-863-4400
Mailing Address - Fax:512-863-5261
Practice Address - Street 1:107 WAGON WHEEL TRL
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2404
Practice Address - Country:US
Practice Address - Phone:512-863-4400
Practice Address - Fax:512-863-5261
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5153TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83805EMedicare PIN
TXU66991Medicare UPIN