Provider Demographics
NPI:1205065620
Name:JUDGE, QUINN L (OD)
Entity type:Individual
Prefix:DR
First Name:QUINN
Middle Name:L
Last Name:JUDGE
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 1:1929 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2953
Mailing Address - Country:US
Mailing Address - Phone:309-787-8341
Mailing Address - Fax:309-787-8345
Practice Address - Street 1:1929 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2953
Practice Address - Country:US
Practice Address - Phone:309-787-8341
Practice Address - Fax:309-787-8345
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010259Medicaid