Provider Demographics
NPI:1700345097
Name:QUIGLEY, MATTHEW J (RDO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-2653
Mailing Address - Country:US
Mailing Address - Phone:661-393-2020
Mailing Address - Fax:661-393-2552
Practice Address - Street 1:2022 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-2653
Practice Address - Country:US
Practice Address - Phone:661-393-2020
Practice Address - Fax:661-393-2552
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5631156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician