Provider Demographics
NPI:1386193050
Name:QUILLA, JAMIN D (OD)
Entity Type:Individual
Prefix:
First Name:JAMIN
Middle Name:D
Last Name:QUILLA
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-0399
Mailing Address - Country:US
Mailing Address - Phone:828-665-1577
Mailing Address - Fax:
Practice Address - Street 1:1431 SMOKY PARK HIGHWAY
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-0399
Practice Address - Country:US
Practice Address - Phone:828-665-1577
Practice Address - Fax:828-667-5061
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3341152W00000X
NC2466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist