Provider Demographics
NPI:1336136266
Name:QUESNELL, DOUGLAS GERALD (OD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:GERALD
Last Name:QUESNELL
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 1:7401 W GRANDRIDGE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7831
Mailing Address - Country:US
Mailing Address - Phone:509-736-0710
Mailing Address - Fax:509-736-0751
Practice Address - Street 1:7405 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6708
Practice Address - Country:US
Practice Address - Phone:509-736-0710
Practice Address - Fax:509-736-0751
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1104TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50524OtherDAVIS VISION
WA15823OtherLABOR AND INDUSTRIES
WA2722304Medicaid
WA15823OtherLABOR AND INDUSTRIES
WA50524OtherDAVIS VISION