Provider Demographics
NPI:1043487143
Name:O'BRIEN, CHRISTOPHER MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:O'BRIEN
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 1:871 PENN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4228
Mailing Address - Country:US
Mailing Address - Phone:914-472-3937
Mailing Address - Fax:770-913-0841
Practice Address - Street 1:1140 HAMMOND DR
Practice Address - Street 2:BLDG E SUITE 5100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-394-4000
Practice Address - Fax:770-913-0841
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006248152W00000X
CA11832152W00000X
GA1895152W00000X
NJ27OA00601800152W00000X
CT002704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist