Individual
BRENDAN QUALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9596 BASE LINE RD, RANCHO CUCAMONGA, CA 91701-5034
(909) 787-1760
Mailing address
9596 BASE LINE RD, RANCHO CUCAMONGA, CA 91701-5034
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002752
AZ
152W00000X
Optometrist
Primary
36187
CA
Other
Enumeration date
10/20/2023
Last updated
07/01/2026
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