Provider Demographics
NPI:1710087937
Name:KIRALY-QUALLS, REBECCA M (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:KIRALY-QUALLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:KIRALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:13841 HULL STREET ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2506
Mailing Address - Country:US
Mailing Address - Phone:804-739-7000
Mailing Address - Fax:804-739-7589
Practice Address - Street 1:13841 HULL STREET ROAD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2506
Practice Address - Country:US
Practice Address - Phone:804-739-7000
Practice Address - Fax:804-739-7589
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA040367OtherANTHEM
410028623OtherRR MEDICARE
2200090OtherUHC
410028623OtherRR MEDICARE
VA040367OtherANTHEM