Provider Demographics
NPI:1356655898
Name:QUANG, KEVIN (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:QUANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:MY
Other - Middle Name:
Other - Last Name:QUANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:591 LINCOLNST.
Mailing Address - Street 2:ARINELLAWILLIAMS LLC
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1932
Mailing Address - Country:US
Mailing Address - Phone:508-853-2020
Mailing Address - Fax:
Practice Address - Street 1:591 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1932
Practice Address - Country:US
Practice Address - Phone:508-853-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088624AMedicaid
MA4845OtherLISC BOARD OF OPTOMETRY
MA110088624AMedicaid
MA002160801Medicare PIN