Provider Demographics
NPI:1336392117
Name:WARD, JUSTIN CURTIS (OD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CURTIS
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4710
Mailing Address - Country:US
Mailing Address - Phone:903-758-8832
Mailing Address - Fax:903-238-8876
Practice Address - Street 1:1821 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4710
Practice Address - Country:US
Practice Address - Phone:903-758-8832
Practice Address - Fax:903-238-8876
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7286TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82494QOtherBLUECROSS BLUESHIELD
TX00157KMedicare PIN
TX82494QOtherBLUECROSS BLUESHIELD