Provider Demographics
NPI:1326187519
Name:ROSER, CHRISTA FAY SCHLENKER (OD FCOVD)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:FAY SCHLENKER
Last Name:ROSER
Suffix:
Gender:F
Credentials:OD FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 SOUTH QUEEN STREET
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313
Mailing Address - Country:US
Mailing Address - Phone:717-741-5531
Mailing Address - Fax:717-741-3001
Practice Address - Street 1:2791 SOUTH QUEEN STREET
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313
Practice Address - Country:US
Practice Address - Phone:717-741-5531
Practice Address - Fax:717-741-3001
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE 6810 P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U40350Medicare UPIN
R0733047Medicare ID - Type Unspecified