Provider Demographics
NPI:1164422101
Name:DIX, CURTIS L (OD PC)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:L
Last Name:DIX
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1603
Mailing Address - Country:US
Mailing Address - Phone:541-475-2020
Mailing Address - Fax:541-475-6118
Practice Address - Street 1:211 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1603
Practice Address - Country:US
Practice Address - Phone:541-475-2020
Practice Address - Fax:541-475-6118
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1421T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218107Medicaid
ORR 134413Medicare PIN
OR218107Medicaid