Provider Demographics
NPI:1326662115
Name:ALFANO, CHRISTY LEIGH (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEIGH
Last Name:ALFANO
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 1:19171 SE MILL PLAIN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9321
Mailing Address - Country:US
Mailing Address - Phone:360-892-0346
Mailing Address - Fax:
Practice Address - Street 1:19171 SE MILL PLAIN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9321
Practice Address - Country:US
Practice Address - Phone:360-892-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4513152W00000X
WAOD61073125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist