Provider Demographics
NPI:1801975198
Name:QUILLIN, STEVEN (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:QUILLIN
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 1:203-205 SHAW AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952
Mailing Address - Country:US
Mailing Address - Phone:302-398-8404
Mailing Address - Fax:302-398-8818
Practice Address - Street 1:203-205 SHAW AVENUE
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952
Practice Address - Country:US
Practice Address - Phone:302-398-8404
Practice Address - Fax:302-398-8818
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5969208OtherAETNA
DEU49096OtherBCBS DE
DE0000167403Medicaid
DEP00319699OtherRAILROAD MEDICARE
DEG01973H02Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
DE0000167403Medicaid