Provider Demographics
NPI:1104227214
Name:QUUXX
Entity type:Organization
Organization Name:QUUXX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER MEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-728-5067
Mailing Address - Street 1:6651 BLACKJACK OAKS RD
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3609
Mailing Address - Country:US
Mailing Address - Phone:214-794-8006
Mailing Address - Fax:
Practice Address - Street 1:6651 BLACKJACK OAKS RD
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-3609
Practice Address - Country:US
Practice Address - Phone:214-794-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty