Provider Demographics
NPI:1669480182
Name:WAXHAW FAMILY VISION CARE OD, PLLC
Entity Type:Organization
Organization Name:WAXHAW FAMILY VISION CARE OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CURETON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-843-3053
Mailing Address - Street 1:3909 PROVIDENCE RD S
Mailing Address - Street 2:SUITE H
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7480
Mailing Address - Country:US
Mailing Address - Phone:704-843-3053
Mailing Address - Fax:
Practice Address - Street 1:3909 PROVIDENCE RD S
Practice Address - Street 2:SUITE H
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7480
Practice Address - Country:US
Practice Address - Phone:704-843-3053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5893260001Medicare NSC