Provider Demographics
NPI:1225105117
Name:QUIGLEY, KENNETH H (RDO)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:H
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-2653
Mailing Address - Country:US
Mailing Address - Phone:661-393-2554
Mailing Address - Fax:
Practice Address - Street 1:2022 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-2653
Practice Address - Country:US
Practice Address - Phone:661-393-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2794156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX002794FMedicaid
CA0680750001Medicare ID - Type Unspecified