Provider Demographics
NPI:1467547570
Name:QUAY, R. DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:R. DOUGLAS
Middle Name:
Last Name:QUAY
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 1:2030 W TILGHMAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:610-432-3258
Mailing Address - Fax:610-289-2100
Practice Address - Street 1:2030 W TILGHMAN ST STE 101
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4354
Practice Address - Country:US
Practice Address - Phone:610-432-3258
Practice Address - Fax:610-289-2100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-T008757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0003330OtherAETNA PIN#
PA51971OtherDAVIS VISION
PA01395401OtherBLUE CROSS
PA0201390001OtherMEDICARE DMERC
PAOE-T008757OtherLICENSE NUMBER
PA0201390001OtherMEDICARE DMERC
PA020068Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA01395401OtherBLUE CROSS