Provider Demographics
NPI:1497748867
Name:CURTIS, WILEY F (OD)
Entity Type:Individual
Prefix:
First Name:WILEY
Middle Name:F
Last Name:CURTIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 E PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6411
Mailing Address - Country:US
Mailing Address - Phone:817-461-4453
Mailing Address - Fax:817-861-2516
Practice Address - Street 1:1334 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6411
Practice Address - Country:US
Practice Address - Phone:817-461-4453
Practice Address - Fax:817-861-2516
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3023TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0202450001OtherMEDICARE DMERC SUPPLIER
T12873Medicare UPIN
TX00E43BMedicare ID - Type Unspecified