Provider Demographics
NPI:1437294832
Name:MCQUAIN, KENT BYRON (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:BYRON
Last Name:MCQUAIN
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 1:5220 GEORGE WASHINGTON MEM HWY
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2759
Mailing Address - Country:US
Mailing Address - Phone:757-898-1000
Mailing Address - Fax:
Practice Address - Street 1:5220 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692-2759
Practice Address - Country:US
Practice Address - Phone:757-898-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009200398Medicaid
VA0833980001Medicare NSC
VA0833980001Medicare PIN