Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | ||
N | 156FC0800X | Contact Lens | ||
Y | 156FX1800X | Optician |
NPI | 1598211153 |
---|---|
Provider Name | Mr. Keith L. Curtis JR. |
First Address | Highland, IN 46322-2648 |
Second Address | Highland, IN 46322-2648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |