Provider Demographics
NPI:1992729909
Name:MASSENGALE, CURT LEROY (OD)
Entity type:Individual
Prefix:DR
First Name:CURT
Middle Name:LEROY
Last Name:MASSENGALE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N. BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160
Mailing Address - Country:US
Mailing Address - Phone:405-631-2020
Mailing Address - Fax:405-631-2114
Practice Address - Street 1:2828 N. BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160
Practice Address - Country:US
Practice Address - Phone:405-631-2020
Practice Address - Fax:405-631-2114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK1089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40553Medicare UPIN