Provider Demographics
NPI:1700960523
Name:R. DOUGLAS QUAY, O.D.
Entity Type:Organization
Organization Name:R. DOUGLAS QUAY, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R. DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-432-3258
Mailing Address - Street 1:2030 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:610-432-3258
Mailing Address - Fax:610-289-2100
Practice Address - Street 1:2030 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4354
Practice Address - Country:US
Practice Address - Phone:610-432-3258
Practice Address - Fax:610-289-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02419600OtherBLUE CROSS
PA02419600OtherBLUE CROSS
PAT27080Medicare UPIN
029277Medicare PIN