Provider Demographics
NPI:1508806068
Name:QUINN, RONALD KEVIN (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KEVIN
Last Name:QUINN
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 142045
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-2045
Mailing Address - Country:US
Mailing Address - Phone:352-331-8672
Mailing Address - Fax:352-331-8672
Practice Address - Street 1:817 NW 56TH TER
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6418
Practice Address - Country:US
Practice Address - Phone:352-331-7771
Practice Address - Fax:352-331-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620585200Medicaid
U67791Medicare UPIN
FL620585200Medicaid