Provider Demographics
NPI:1598301616
Name:QUACH, JUDY (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:QUACH
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 1:2316 EASTGATE ST STE 170
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1576
Mailing Address - Country:US
Mailing Address - Phone:480-370-9917
Mailing Address - Fax:
Practice Address - Street 1:2316 EASTGATE ST STE 170
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1576
Practice Address - Country:US
Practice Address - Phone:509-529-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9618152W00000X
WAOD61051669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist