Provider Demographics
NPI:1821102138
Name:MCQUEEN, DAVID ANDREW (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1070 IYANNOUGH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1871
Mailing Address - Country:US
Mailing Address - Phone:508-771-9701
Mailing Address - Fax:508-778-6663
Practice Address - Street 1:1070 IYANNOUGH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1871
Practice Address - Country:US
Practice Address - Phone:508-771-9701
Practice Address - Fax:508-778-6663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEW20183OtherBLUE CROSS BLUE SHIELD
MA0391867Medicaid
MAHP150463OtherHARVARD PILGRIM
MA0391867Medicaid
MA42995801Medicare PIN