Provider Demographics
NPI:1194707927
Name:MCQUILLAN, MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MCQUILLAN
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 1:1200 PASEO CAMARILLO
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6050
Mailing Address - Country:US
Mailing Address - Phone:805-484-0577
Mailing Address - Fax:805-987-6257
Practice Address - Street 1:1200 PASEO CAMARILLO
Practice Address - Street 2:SUITE 180
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6050
Practice Address - Country:US
Practice Address - Phone:805-484-0577
Practice Address - Fax:805-987-6257
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6508T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP6508AMedicare PIN
CAT10344Medicare UPIN