Provider Demographics
NPI:1881844249
Name:CURTIS E. ROBERSON,OD INC
Entity Type:Organization
Organization Name:CURTIS E. ROBERSON,OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-354-6614
Mailing Address - Street 1:1221 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3839
Mailing Address - Country:US
Mailing Address - Phone:405-354-6614
Mailing Address - Fax:405-354-6615
Practice Address - Street 1:1221 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3839
Practice Address - Country:US
Practice Address - Phone:405-354-6614
Practice Address - Fax:405-354-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764860CMedicaid
OKOK700274Medicare PIN
OK0871120001Medicare NSC