Provider Demographics
NPI:1699767285
Name:BAXSTROM, CURTIS R (OD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:R
Last Name:BAXSTROM
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 1:1705 S 324TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8504
Mailing Address - Country:US
Mailing Address - Phone:253-661-6005
Mailing Address - Fax:253-661-0633
Practice Address - Street 1:1705 S 324TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8504
Practice Address - Country:US
Practice Address - Phone:253-661-6005
Practice Address - Fax:253-661-0633
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1583TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015261Medicaid
WATO2220Medicare UPIN
WA2015261Medicaid