Provider Demographics
NPI:1538444757
Name:CURTIS OPHTHALMOLOGY PLLC
Entity type:Organization
Organization Name:CURTIS OPHTHALMOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-239-5460
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1545
Mailing Address - Country:US
Mailing Address - Phone:607-239-5460
Mailing Address - Fax:607-239-5465
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:SUITE1
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1545
Practice Address - Country:US
Practice Address - Phone:607-239-5460
Practice Address - Fax:607-239-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259317207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000663780OtherGHI-HMO
NY03401952Medicaid
NY259317OtherLICENSE
4401346OtherMVP
NY259317OtherLICENSE