Provider Demographics
NPI:1386759868
Name:CAUGH, KURTIS (OD)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:CAUGH
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:P O BOX 761
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0761
Mailing Address - Country:US
Mailing Address - Phone:843-281-8181
Mailing Address - Fax:843-281-9009
Practice Address - Street 1:550 HIGHWAY 17 NORTH
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2904
Practice Address - Country:US
Practice Address - Phone:843-281-8181
Practice Address - Fax:843-692-3094
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD11841Medicaid
SCD11841Medicaid