Provider Demographics
NPI:1518641307
Name:CHASE, CHRISTY
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 NE 57TH TER
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5512
Mailing Address - Country:US
Mailing Address - Phone:816-832-8105
Mailing Address - Fax:
Practice Address - Street 1:2510 NE 57TH TER
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5512
Practice Address - Country:US
Practice Address - Phone:816-832-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022005073156FX1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptistGroup - Single Specialty