Provider Demographics
NPI:1205838562
Name:DEVINE, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:DEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:2055 READING RD
Practice Address - Street 2:STE 330
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1439
Practice Address - Country:US
Practice Address - Phone:513-381-1900
Practice Address - Fax:513-287-6403
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.074600207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
180034367OtherMEDICARE RAILROAD
IN200112050Medicaid
KY64925043Medicaid
OH2072840Medicaid
OHG23546Medicare UPIN
KY64925043Medicaid
OH0860091Medicare PIN
KY0346308Medicare PIN