Provider Demographics
NPI:1942273446
Name:QUARANTA, J KEVIN (OD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:KEVIN
Last Name:QUARANTA
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 1:2211 E PECOS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6142
Mailing Address - Country:US
Mailing Address - Phone:480-812-2211
Mailing Address - Fax:480-776-2738
Practice Address - Street 1:2211 E PECOS RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6142
Practice Address - Country:US
Practice Address - Phone:480-812-2211
Practice Address - Fax:480-776-2738
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ122755Medicare PIN
AZZ122754Medicare PIN
AZ21110Medicare ID - Type Unspecified
AZZ21110Medicare PIN