Provider Demographics
NPI:1629112156
Name:QUITADAMO, PAUL FRANCIS (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FRANCIS
Last Name:QUITADAMO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:SUNAPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03782-3500
Mailing Address - Country:US
Mailing Address - Phone:603-863-9385
Mailing Address - Fax:
Practice Address - Street 1:267 PLAINFIELD RD
Practice Address - Street 2:EYEGLASS OUTLET
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2017
Practice Address - Country:US
Practice Address - Phone:603-298-8841
Practice Address - Fax:603-298-7950
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA5178156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician