Provider Demographics
NPI:1851435366
Name:QUINLAN, DANIEL ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:QUINLAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BROADWAY
Mailing Address - Street 2:PO BOX 1036
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002
Mailing Address - Country:US
Mailing Address - Phone:270-443-3202
Mailing Address - Fax:270-443-3202
Practice Address - Street 1:609 BROADWAY
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42002
Practice Address - Country:US
Practice Address - Phone:270-443-3202
Practice Address - Fax:270-443-3202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY913DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T54656Medicare UPIN
KY9156801Medicare PIN
KY0635250001Medicare NSC