Provider Demographics
NPI:1255490504
Name:CHRISAGIS, JOHN N (O D P C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:N
Last Name:CHRISAGIS
Suffix:
Gender:M
Credentials:O D P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 S MC CLINTOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283
Mailing Address - Country:US
Mailing Address - Phone:480-967-4910
Mailing Address - Fax:480-966-5992
Practice Address - Street 1:7511 S MC CLINTOCK DRIVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:480-967-4910
Practice Address - Fax:480-966-5992
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860517098OtherTAX ID NUMBER
AZ860517098OtherTAX ID NUMBER
AZT41489Medicare UPIN