Provider Demographics
NPI:1376389395
Name:QUACH, JOANNA (OD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:QUACH
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 1:500 W CAMELBACK RD UNIT 228
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-0004
Mailing Address - Country:US
Mailing Address - Phone:347-459-8251
Mailing Address - Fax:
Practice Address - Street 1:650 EAST INDIAN SCHOOL ROAD
Practice Address - Street 2:EYE CLINIC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist