Provider Demographics
NPI:1902948383
Name:R Q OPTOMETRY
Entity Type:Organization
Organization Name:R Q OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-941-7112
Mailing Address - Street 1:2777 SHAVER ST STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-4625
Mailing Address - Country:US
Mailing Address - Phone:713-941-7112
Mailing Address - Fax:713-941-7112
Practice Address - Street 1:2777 SHAVER ST STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-4625
Practice Address - Country:US
Practice Address - Phone:713-941-7112
Practice Address - Fax:713-941-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4593T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019581001Medicaid
00E96PMedicare ID - Type Unspecified
U29289Medicare UPIN