Provider Demographics
NPI:1083825798
Name:THOMAS O MCCURDY OD INC PS
Entity Type:Organization
Organization Name:THOMAS O MCCURDY OD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-457-1032
Mailing Address - Street 1:504 E 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6246
Mailing Address - Country:US
Mailing Address - Phone:360-457-1032
Mailing Address - Fax:360-452-9604
Practice Address - Street 1:504 E 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6246
Practice Address - Country:US
Practice Address - Phone:360-457-1032
Practice Address - Fax:360-452-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G000500094Medicare PIN