Provider Demographics
NPI:1336142892
Name:BLANTON, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:BLANTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4614
Mailing Address - Country:US
Mailing Address - Phone:909-825-3425
Mailing Address - Fax:909-825-6991
Practice Address - Street 1:1900 E WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4614
Practice Address - Country:US
Practice Address - Phone:909-825-3425
Practice Address - Fax:909-825-6991
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61733207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G617330OtherBLUE CROSS
CA00G617330Medicaid
CA00G617330OtherBLUE CROSS
CAG15086Medicare UPIN
CA180023676Medicare PIN