Provider Demographics
NPI:1699126656
Name:MCCURDY, SCOTT J (OPTICIAN)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:MCCURDY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 1ST N
Mailing Address - Street 2:#2
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1614
Mailing Address - Country:US
Mailing Address - Phone:208-308-0477
Mailing Address - Fax:
Practice Address - Street 1:110 E 1ST N
Practice Address - Street 2:#2
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1614
Practice Address - Country:US
Practice Address - Phone:208-308-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician