Provider Demographics
NPI:1497844690
Name:MILLET, CURTIS (OD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:MILLET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2001
Mailing Address - Country:US
Mailing Address - Phone:801-886-2020
Mailing Address - Fax:801-954-0054
Practice Address - Street 1:2190 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2807
Practice Address - Country:US
Practice Address - Phone:801-487-4138
Practice Address - Fax:801-467-4813
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3462719934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT99900797009Medicaid
UT0618950016Medicare NSC
004615014Medicare PIN
UT0618950002Medicare NSC
UT0618950011Medicare NSC
UT99900797009Medicaid
UT0618950019Medicare NSC
UT009763014Medicare PIN
UT009922014Medicare ID - Type UnspecifiedMEDICARE
UT009841016Medicare PIN
UTP00091151Medicare PIN
UT009926014Medicare PIN
UTU66613Medicare UPIN
UT009841014Medicare ID - Type UnspecifiedMEDICARE
UT009308013Medicare PIN