Provider Demographics
NPI:1699775874
Name:QUINN, JAMES LAWRENCE (OD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:QUINN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1012 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-2337
Mailing Address - Country:US
Mailing Address - Phone:402-873-7050
Mailing Address - Fax:402-873-7050
Practice Address - Street 1:1012 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2337
Practice Address - Country:US
Practice Address - Phone:402-873-7050
Practice Address - Fax:402-873-7050
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0920249Medicaid
NE470637882 00Medicaid
T40296Medicare UPIN
NE470637882 00Medicaid
0163820001Medicare NSC