Provider Demographics
NPI:1710994298
Name:CURTIS, JOHN DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
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 1:3830 W VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1061
Mailing Address - Country:US
Mailing Address - Phone:417-881-9784
Mailing Address - Fax:417-881-9799
Practice Address - Street 1:3520 W SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-0906
Practice Address - Country:US
Practice Address - Phone:417-881-9784
Practice Address - Fax:417-881-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO315714808Medicaid
MOU78000Medicare UPIN
MO000091265Medicare ID - Type UnspecifiedMEDICARE W. SUNSHINE