Provider Demographics
NPI:1235145764
Name:KANTOR, CHRISTINE JACQUELINE (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JACQUELINE
Last Name:KANTOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5300
Mailing Address - Country:US
Mailing Address - Phone:203-869-2255
Mailing Address - Fax:203-869-0333
Practice Address - Street 1:41 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5300
Practice Address - Country:US
Practice Address - Phone:203-869-2255
Practice Address - Fax:203-869-0333
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPOP54152W00000X
MDTA2799152W00000X
NJ27OA00624600152W00000X
WI21338-875152W00000X
VA0618003056152W00000X
PAOEG003769152W00000X
WI3876-35152W00000X
NYTUV007056152WC0802X
CT002697152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist