Provider Demographics
NPI:1194504696
Name:MAXWELL, CURT (LDO)
Entity type:Individual
Prefix:
First Name:CURT
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 GREENWELL LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0764
Mailing Address - Country:US
Mailing Address - Phone:417-825-0566
Mailing Address - Fax:
Practice Address - Street 1:632 GRASSFIELD PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7449
Practice Address - Country:US
Practice Address - Phone:757-312-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002764156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician