Provider Demographics
NPI:1144371451
Name:QUAN, BRIAN (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:QUAN
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 1:360 BEACH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2712
Mailing Address - Country:US
Mailing Address - Phone:650-346-1357
Mailing Address - Fax:
Practice Address - Street 1:700 EL CAMINO REAL
Practice Address - Street 2:160 MENLO STATION
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4847
Practice Address - Country:US
Practice Address - Phone:650-329-8181
Practice Address - Fax:650-329-1069
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12949T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0129490Medicare ID - Type Unspecified