1609229277 NPI number — ADRIENNE CAITLYN QUAN O.D.

Table of content: ADRIENNE CAITLYN QUAN O.D. (NPI 1609229277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609229277 NPI number — ADRIENNE CAITLYN QUAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAN
Provider First Name:
ADRIENNE
Provider Middle Name:
CAITLYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAN
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
CAITLYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609229277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 31ST STREET
Provider Second Line Business Mailing Address:
WHITE OAK HALL, SUITE 308-K
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-960-3183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 LACEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-743-4800
Provider Business Practice Location Address Fax Number:
630-743-4839
Provider Enumeration Date:
07/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046011088 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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