Provider Demographics
NPI:1467587907
Name:GREEN, CHRISTINA BERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:BERRY
Last Name:GREEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10841 S CROSSROADS DR STE 12
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9090
Mailing Address - Country:US
Mailing Address - Phone:303-841-6969
Mailing Address - Fax:303-841-1507
Practice Address - Street 1:10841 S CROSSROADS DR STE 12
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9090
Practice Address - Country:US
Practice Address - Phone:303-841-6969
Practice Address - Fax:303-841-1507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist