Provider Demographics
NPI:1104019561
Name:CURTIS OPTOMETRY CLINIC AND DISPENSARY, P.A.
Entity Type:Organization
Organization Name:CURTIS OPTOMETRY CLINIC AND DISPENSARY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:662-328-5225
Mailing Address - Street 1:PO BOX 9099
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-0038
Mailing Address - Country:US
Mailing Address - Phone:662-328-5225
Mailing Address - Fax:
Practice Address - Street 1:1823 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2203
Practice Address - Country:US
Practice Address - Phone:662-328-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880218Medicaid
MSU94002Medicare UPIN
MS00880218Medicaid
MS410000352Medicare PIN
MS410000354Medicare PIN
MS0622440001Medicare NSC