Provider Demographics
NPI:1275585986
Name:CHRISTIE, ELAINE P (OD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:P
Last Name:CHRISTIE
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 1:255 HIGHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1146
Mailing Address - Country:US
Mailing Address - Phone:610-565-7702
Mailing Address - Fax:
Practice Address - Street 1:255 HIGHVIEW LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1146
Practice Address - Country:US
Practice Address - Phone:610-565-7702
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU07722Medicare UPIN