Provider Demographics
NPI:1598912545
Name:BISHOP, CHRISTINE BRENNAN (OPTOMETRIST)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BRENNAN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S PARROTT AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5138
Mailing Address - Country:US
Mailing Address - Phone:863-467-0595
Mailing Address - Fax:863-467-1686
Practice Address - Street 1:710 S PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5138
Practice Address - Country:US
Practice Address - Phone:863-467-0595
Practice Address - Fax:863-467-1686
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC004298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000KQOtherBLUE CROSS BLUE SHIEL
FL000488100Medicaid
FL000KQOtherBLUE CROSS BLUE SHIEL