Basic Information
| Provider Information | |||||||||
| NPI: | 1134219801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | THEODORE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WHITING HILL RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044121006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079735000 | ||||||||
| FaxNumber: | 2079735042 | ||||||||
| Practice Location | |||||||||
| Address1: | 885 UNION ST | ||||||||
| Address2: | SUITE 120/130 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079738876 | ||||||||
| FaxNumber: | 2079736058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 43728 | CO | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD60035767 | WA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 259317 | NY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 24367 | ME | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | BC8785264 | 01 | DEA | OTHER | 259317 | 01 | NY | LICENSE | OTHER | 03401952 | 05 | NY | MEDICAID | MD60035767 | 01 | WA | LICENSE | OTHER |