Provider Demographics
NPI:1780630863
Name:DEVITO, KURT K (OD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:K
Last Name:DEVITO
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:PO BOX 45923
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5923
Mailing Address - Country:US
Mailing Address - Phone:877-969-0392
Mailing Address - Fax:
Practice Address - Street 1:125 JANAF SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2501
Practice Address - Country:US
Practice Address - Phone:757-461-3101
Practice Address - Fax:757-461-6942
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA453835OtherBCBS
VA009236449Medicaid
4323400003OtherDME
VA009236449Medicaid
VA410001281Medicare ID - Type Unspecified