Provider Demographics
NPI:1174575401
Name:CURTIS, CHRISTINA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LYNN
Last Name:CURTIS
Suffix:
Gender:F
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:N6549 BOARDING HOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49834
Mailing Address - Country:US
Mailing Address - Phone:906-282-7120
Mailing Address - Fax:
Practice Address - Street 1:N 6549 BOARDING HOUSE ROAD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:MI
Practice Address - Zip Code:49834
Practice Address - Country:US
Practice Address - Phone:906-282-7120
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38628500Medicaid
P06320002Medicare ID - Type Unspecified
U83672Medicare UPIN