Basic Information
| Provider Information | |||||||||
| NPI: | 1750498135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CURL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1290 | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245511290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343855400 | ||||||||
| FaxNumber: | 4344557172 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 OLD COURTHOUSE RD | ||||||||
| Address2: | |||||||||
| City: | APPOMATTOX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245229853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343855400 | ||||||||
| FaxNumber: | 4344557172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618001585 | VA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0618001585 | 01 | VA | STATE LICIENSE | OTHER | P00399158 | 01 | VA | MEDICARE RAILROAD | OTHER | P00458189 | 01 | VA | MEDICARE RAILROAD | OTHER |