Provider Demographics
NPI:1508972506
Name:MCQUITTY, JERILYN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JERILYN
Middle Name:ANN
Last Name:MCQUITTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 CHERRY TREE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9614
Mailing Address - Country:US
Mailing Address - Phone:317-574-9679
Mailing Address - Fax:
Practice Address - Street 1:2001 E 151ST ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7737
Practice Address - Country:US
Practice Address - Phone:317-844-0613
Practice Address - Fax:317-844-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002388B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU22088Medicare UPIN
IN366110Medicare ID - Type Unspecified