Provider Demographics
NPI:1447258934
Name:PAQUIN, DENISE LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LOUISE
Last Name:PAQUIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7771 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2879
Mailing Address - Country:US
Mailing Address - Phone:703-361-8284
Mailing Address - Fax:703-361-0318
Practice Address - Street 1:7771 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2879
Practice Address - Country:US
Practice Address - Phone:703-361-8284
Practice Address - Fax:703-361-0318
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410000001Medicare PIN
0244380001Medicare NSC
T91129Medicare UPIN
410031617Medicare PIN