Provider Demographics
NPI:1679649677
Name:KURTZ, CRAIG BOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BOYD
Last Name:KURTZ
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 1:1014 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931
Mailing Address - Country:US
Mailing Address - Phone:906-482-6800
Mailing Address - Fax:906-482-5120
Practice Address - Street 1:1014 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931
Practice Address - Country:US
Practice Address - Phone:906-482-6800
Practice Address - Fax:906-482-5120
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI945026180Medicaid
MI0286600001Medicare NSC
MI945026180Medicaid