Provider Demographics
NPI:1053497016
Name:ZUPSIC, CHRISTOPHER E (OD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:E
Last Name:ZUPSIC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:E
Other - Last Name:ZUPSIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:928 GREENTREE SQUARE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-596-8883
Mailing Address - Fax:856-596-7874
Practice Address - Street 1:928 GREENTREE SQUARE ROUTE 73
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-596-8883
Practice Address - Fax:856-596-7874
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00549101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ022446Medicare ID - Type Unspecified