Healthcare Provider Details

I. General information

NPI: 1386759868
Provider Name (Legal Business Name): KURTIS CAUGH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HIGHWAY 17 NORTH
NORTH MYRTLE BEACH SC
29582-2904
US

IV. Provider business mailing address

P O BOX 761
LITTLE RIVER SC
29566-0761
US

V. Phone/Fax

Practice location:
  • Phone: 843-281-8181
  • Fax: 843-692-3094
Mailing address:
  • Phone: 843-281-8181
  • Fax: 843-281-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1184
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: