Provider Demographics
NPI:1063474575
Name:INCLIMA, CHRISTOPHER M (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:INCLIMA
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 1:415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4296
Mailing Address - Country:US
Mailing Address - Phone:203-934-5126
Mailing Address - Fax:203-932-2020
Practice Address - Street 1:415 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4296
Practice Address - Country:US
Practice Address - Phone:203-934-5126
Practice Address - Fax:203-932-2020
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTO.D.0V0550OtherHEALTHNET
CT0420939002OtherCIGNA
CTP378085OtherOXFORD
CT4335533OtherAETNA
CT004123882Medicaid
CT090002312CT01OtherANTHEM
CT22-04190OtherUNITED HEALTHCARE
CT22-04190OtherUNITED HEALTHCARE
CT410000579Medicare PIN
CT004123882Medicaid