Provider Demographics
NPI:1558336628
Name:WOMACK, CHRISTINA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WOMACK
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 1:3885 COCHRAN ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2369
Mailing Address - Country:US
Mailing Address - Phone:805-522-7007
Mailing Address - Fax:805-522-7886
Practice Address - Street 1:3885 COCHRAN ST
Practice Address - Street 2:SUITE L
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2369
Practice Address - Country:US
Practice Address - Phone:805-522-7007
Practice Address - Fax:805-522-7886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11083T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU72836Medicare UPIN