Provider Demographics
NPI:1982889143
Name:CURTIS L. DIX, OD, PC
Entity Type:Organization
Organization Name:CURTIS L. DIX, OD, PC
Other - Org Name:MADRAS VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-475-2020
Mailing Address - Street 1:211 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1603
Mailing Address - Country:US
Mailing Address - Phone:541-475-2020
Mailing Address - Fax:541-475-6118
Practice Address - Street 1:211 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1603
Practice Address - Country:US
Practice Address - Phone:541-475-2020
Practice Address - Fax:541-475-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1381T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218107Medicaid
ORR 134412Medicare PIN
OR218107Medicaid
OR5601410001Medicare NSC