Provider Demographics
NPI:1215977871
Name:MCQUIRTER, HENRY G (OD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:G
Last Name:MCQUIRTER
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 1:825 RIDGE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9411
Mailing Address - Country:US
Mailing Address - Phone:901-685-2200
Mailing Address - Fax:901-820-2342
Practice Address - Street 1:825 RIDGE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9411
Practice Address - Country:US
Practice Address - Phone:901-685-2200
Practice Address - Fax:901-820-2342
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN200683OtherWELLCARE
925130OtherBLOCK VISION
TN3595398Medicaid
5099554OtherAETNA
TNP00279229OtherRR MEDICARE
4111863OtherBCBS
MS00087053Medicaid
TN200683OtherWELLCARE
TN3595398Medicaid