Provider Demographics
NPI:1164777058
Name:WEBER, CHRISTOPHER PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:WEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1301 W EVERGREEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1634
Mailing Address - Country:US
Mailing Address - Phone:217-342-3838
Mailing Address - Fax:217-342-3880
Practice Address - Street 1:1301 W EVERGREEN AVE STE B
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1634
Practice Address - Country:US
Practice Address - Phone:217-342-3838
Practice Address - Fax:217-342-3880
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL762990001Medicare PIN