Provider Demographics
NPI:1992862056
Name:QUIGLEY, COLM (OD)
Entity Type:Individual
Prefix:DR
First Name:COLM
Middle Name:
Last Name:QUIGLEY
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 1:29 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2576
Mailing Address - Country:US
Mailing Address - Phone:781-438-1310
Mailing Address - Fax:
Practice Address - Street 1:739 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3207
Practice Address - Country:US
Practice Address - Phone:781-231-1097
Practice Address - Fax:781-231-1099
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7737155OtherAETNA US HEALTH CARE
MAW16441OtherBLUE CROSS & BLUE SHIELD
MA935425OtherEYEMED VISION CARE
MAQUW17575Medicare ID - Type Unspecified