Provider Demographics
NPI:1346333176
Name:SMITH, CHRISTOPHER D (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:503 DOCTORS CT
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2025
Mailing Address - Country:US
Mailing Address - Phone:920-236-3540
Mailing Address - Fax:920-236-3546
Practice Address - Street 1:223 S NICOLET RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3938
Practice Address - Country:US
Practice Address - Phone:920-733-5888
Practice Address - Fax:920-733-5151
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WITPA2797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38622300Medicaid
WI000207760Medicare PIN
WI000771057Medicare PIN
WIU78719Medicare UPIN