| Doctor Name: | ANDREW PALMQUIST |
| NPI Number: | 1386092625 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 1851 |
| Business Practice Address: | 4435 Manchester Dr Rockford, IL - 611091655 |
| Business Phone Number: | 8159644191 |
| Business Fax Number: | 8159648378 |
| Mailing Address: | 4435 Manchester Dr, ROCKFORD |
| State: | IL |
| Postal Code: | 611091655 |
| Phone Number: | 8159644191 |
| Fax Number: | 8159648378 |
| NPI Enumeration Date: | 05/26/2016 |
| NPI Last Update Date: | 05/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156F00000X |
| License Number: | 1851 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A broad category grouping different kinds of technologists and technicians. See individual definitions. |