Provider Demographics
NPI:1073885232
Name:ANTONINI, CHRISTOPHER (BCO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:ANTONINI
Suffix:
Gender:M
Credentials:BCO
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Mailing Address - Street 1:ANTONINI OCULAR PROSTHETICS, LLC
Mailing Address - Street 2:1408 FAR MEADOWS
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508
Mailing Address - Country:US
Mailing Address - Phone:877-594-0719
Mailing Address - Fax:364-241-1858
Practice Address - Street 1:ANTONINI OCULAR PROSTHETICS, LLC
Practice Address - Street 2:WVU EYE INSTITUTE, 1 MEDICAL CENTER DRIVE
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:877-594-0719
Practice Address - Fax:304-241-1858
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381002299Medicaid
WV381002299Medicaid