Provider Demographics
NPI:1225019771
Name:CONROY, CHRISTOPHER J (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:CONROY
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 1:217 3RD STREET
Mailing Address - Street 2:NW
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278
Mailing Address - Country:US
Mailing Address - Phone:320-839-2608
Mailing Address - Fax:320-839-2601
Practice Address - Street 1:217 3RD STREET NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278
Practice Address - Country:US
Practice Address - Phone:320-839-2608
Practice Address - Fax:320-839-2601
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN377725100Medicaid
MN410037854OtherRAILROAD MEDICARE
SD9203082Medicaid
MN4758330001Medicare NSC
MN377725100Medicaid
MN4758330002Medicare NSC
MN410037854OtherRAILROAD MEDICARE
MN410037854OtherRAILROAD MEDICARE
MN410001866Medicare ID - Type Unspecified