Provider Demographics
NPI: | 1538597588 |
---|---|
Name: | MICHAEL A. CURTIS OD PLC |
Entity type: | Organization |
Organization Name: | MICHAEL A. CURTIS OD PLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/OPERATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | CURTIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 870-358-2236 |
Mailing Address - Street 1: | PO BOX 359 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARKED TREE |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72365-0359 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 870-358-2236 |
Mailing Address - Fax: | 870-358-4692 |
Practice Address - Street 1: | 116 NATHAN ST |
Practice Address - Street 2: | |
Practice Address - City: | MARKED TREE |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72365-1448 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-358-2236 |
Practice Address - Fax: | 870-358-4692 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-10-29 |
Last Update Date: | 2013-10-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | 2676 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |