Provider Demographics
NPI:1821274648
Name:IRVING, QUATRISA (OD)
Entity Type:Individual
Prefix:DR
First Name:QUATRISA
Middle Name:
Last Name:IRVING
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 1:1200 E COUNTY LINE RD
Mailing Address - Street 2:STE 166
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1949
Mailing Address - Country:US
Mailing Address - Phone:601-957-6078
Mailing Address - Fax:601-957-6924
Practice Address - Street 1:1200 E COUNTY LINE RD
Practice Address - Street 2:STE 166
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1949
Practice Address - Country:US
Practice Address - Phone:601-957-6078
Practice Address - Fax:601-957-6924
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist