Provider Demographics
NPI:1184694010
Name:MCCURDY, E CRAIG (OD)
Entity type:Individual
Prefix:
First Name:E
Middle Name:CRAIG
Last Name:MCCURDY
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 1:1730 NOVATO BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3048
Mailing Address - Country:US
Mailing Address - Phone:415-897-1161
Mailing Address - Fax:415-899-9871
Practice Address - Street 1:1730 NOVATO BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3048
Practice Address - Country:US
Practice Address - Phone:415-897-1161
Practice Address - Fax:415-899-9871
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7005TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00225029OtherMEDICARE RAILROAD
CAP00225029OtherMEDICARE RAILROAD
CASD0070050Medicare ID - Type UnspecifiedEMPLOYER IDENTIFICATION