Healthcare Provider Details

I. General information

NPI: 1700840378
Provider Name (Legal Business Name): MARK D CURTIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N MAGUIRE ST
WARRENSBURG MO
64093-1420
US

IV. Provider business mailing address

608 N MAGUIRE ST
WARRENSBURG MO
64093-1420
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-7300
  • Fax: 660-747-5322
Mailing address:
  • Phone: 660-747-7300
  • Fax: 660-747-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO3302
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: