Provider Demographics
NPI:1811082621
Name:QUINLAN, TIMOTHY RALPH (PHD, OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RALPH
Last Name:QUINLAN
Suffix:
Gender:M
Credentials:PHD, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PINE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4938
Mailing Address - Country:US
Mailing Address - Phone:845-338-1964
Mailing Address - Fax:
Practice Address - Street 1:240 LUCAS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4316
Practice Address - Country:US
Practice Address - Phone:845-339-4990
Practice Address - Fax:845-339-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0069521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU87610Medicare UPIN