Provider Demographics
NPI:1578536041
Name:PERSONIUS, CHRISTINA MARIE (OD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:PERSONIUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:HARNOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3921 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-5502
Mailing Address - Country:US
Mailing Address - Phone:610-269-9595
Mailing Address - Fax:610-269-9613
Practice Address - Street 1:3921 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-5502
Practice Address - Country:US
Practice Address - Phone:610-269-9595
Practice Address - Fax:610-269-9613
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000707152W00000X
MA4094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2927764OtherAETNA
PAPA0707OtherEYE MED
PAP00080142OtherRAILROAD MEDICARE
PAPE 1313911OtherBC BS
217381OtherCOLE
PAPE 1313911OtherBC BS
U73749Medicare UPIN