Provider Demographics
NPI:1659551794
Name:GEORGE W CURNUTT OD PC
Entity Type:Organization
Organization Name:GEORGE W CURNUTT OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CURNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-397-4911
Mailing Address - Street 1:2020 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1737
Mailing Address - Country:US
Mailing Address - Phone:503-397-4911
Mailing Address - Fax:503-397-3986
Practice Address - Street 1:2020 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1737
Practice Address - Country:US
Practice Address - Phone:503-397-4911
Practice Address - Fax:503-397-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2010-11-12
Deactivation Date:2008-05-20
Deactivation Code:
Reactivation Date:2010-11-12
Provider Licenses
StateLicense IDTaxonomies
OR957ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026336Medicaid
ORT67550Medicare UPIN
OR0613520001Medicare NSC