Provider Demographics
NPI:1043280647
Name:TASSO, CHRISTINE ANN (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:TASSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:BURCHARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:7015 KULCHAY CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9100
Mailing Address - Country:US
Mailing Address - Phone:907-575-2336
Mailing Address - Fax:
Practice Address - Street 1:7015 KULCHAY CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9100
Practice Address - Country:US
Practice Address - Phone:907-575-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD36553Medicaid
U93429Medicare UPIN
U93429Medicare UPIN