Provider Demographics
NPI:1417127150
Name:CHRISTIANA V. MONTGOMERY, O.D., P.C.
Entity Type:Organization
Organization Name:CHRISTIANA V. MONTGOMERY, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:VANZANT
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-899-2905
Mailing Address - Street 1:5626 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5310
Mailing Address - Country:US
Mailing Address - Phone:423-899-2905
Mailing Address - Fax:
Practice Address - Street 1:5626 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5310
Practice Address - Country:US
Practice Address - Phone:423-899-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty