1538444757 NPI number — CURTIS OPHTHALMOLOGY PLLC

Table of content: (NPI 1538444757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538444757 NPI number — CURTIS OPHTHALMOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURTIS OPHTHALMOLOGY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538444757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
VESTAL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13850-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-239-5460
Provider Business Mailing Address Fax Number:
607-239-5465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE1
Provider Business Practice Location Address City Name:
VESTAL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13850-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-239-5460
Provider Business Practice Location Address Fax Number:
607-239-5465
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
607-239-5460

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  259317 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000663780 . This is a "GHI-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03401952 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 259317 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4401346 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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