Provider Demographics
NPI:1417086950
Name:JAVENES, CHRISTINE M (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:JAVENES
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 1:253 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2611
Mailing Address - Country:US
Mailing Address - Phone:845-238-9648
Mailing Address - Fax:
Practice Address - Street 1:110 E 40TH ST
Practice Address - Street 2:RM 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1820
Practice Address - Country:US
Practice Address - Phone:212-433-3937
Practice Address - Fax:212-749-3025
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0005298152W00000X
NYTUV005298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU1951Medicare UPIN
NYCO6461Medicare ID - Type Unspecified