Provider Demographics
NPI:1649436551
Name:QUINTAL, CRAIG JOHN (OD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOHN
Last Name:QUINTAL
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 1:7400 SPRINGLAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-3049
Mailing Address - Country:US
Mailing Address - Phone:504-957-1545
Mailing Address - Fax:
Practice Address - Street 1:4225 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4338
Practice Address - Country:US
Practice Address - Phone:504-371-9355
Practice Address - Fax:985-652-8371
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1569-601T152W00000X
LA1948-884AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1814458Medicaid
MS07375720Medicaid
MS07375720Medicaid
LA4M7797061Medicare PIN