Provider Demographics
NPI:1003868829
Name:RENNER, CHRISTOPHER JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:RENNER
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 1:5653 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAILEYS CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2872
Mailing Address - Country:US
Mailing Address - Phone:703-578-3600
Mailing Address - Fax:703-379-6089
Practice Address - Street 1:5653 COLUMBIA PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:BAILEYS CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22041-2872
Practice Address - Country:US
Practice Address - Phone:703-578-3600
Practice Address - Fax:703-379-6089
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA009206531Medicaid
VAVA009206531Medicaid
RE516266Medicare ID - Type Unspecified