Provider Demographics
NPI:1609361302
Name:QUEVILLON, CAITLIN JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:JOY
Last Name:QUEVILLON
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 1:4604 BELLAMY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7949
Mailing Address - Country:US
Mailing Address - Phone:561-713-8385
Mailing Address - Fax:
Practice Address - Street 1:1550 TOMCAT BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23460-2218
Practice Address - Country:US
Practice Address - Phone:757-953-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT000.3392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist