Provider Demographics
NPI:1609229277
Name:QUAN, ADRIENNE CAITLYN (OD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:CAITLYN
Last Name:QUAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:CAITLYN
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:555 31ST STREET
Mailing Address - Street 2:WHITE OAK HALL, SUITE 308-K
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1235
Mailing Address - Country:US
Mailing Address - Phone:630-960-3183
Mailing Address - Fax:
Practice Address - Street 1:3450 LACEY RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5430
Practice Address - Country:US
Practice Address - Phone:630-743-4800
Practice Address - Fax:630-743-4839
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011088152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist