Provider Demographics
NPI:1417980186
Name:DANIEL E. QUON, O.D. INC.
Entity Type:Organization
Organization Name:DANIEL E. QUON, O.D. INC.
Other - Org Name:SOUTH COAST OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:QUON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-540-2020
Mailing Address - Street 1:949 SOUTH COAST DRIVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7737
Mailing Address - Country:US
Mailing Address - Phone:714-540-2020
Mailing Address - Fax:714-540-5844
Practice Address - Street 1:949 S COAST DR
Practice Address - Street 2:SUITE 155
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7737
Practice Address - Country:US
Practice Address - Phone:714-540-2020
Practice Address - Fax:714-540-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 05749T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU38003Medicare UPIN
CAWOP5749AMedicare ID - Type UnspecifiedMEDICARE PARRT B