Provider Demographics
NPI:1619076247
Name:CHONTOS, TODD ERNEST (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ERNEST
Last Name:CHONTOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 CROSSROADS CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4908
Mailing Address - Country:US
Mailing Address - Phone:614-863-0195
Mailing Address - Fax:
Practice Address - Street 1:4427 CROSSROADS CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4908
Practice Address - Country:US
Practice Address - Phone:614-863-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3931OtherEYEMED
OHCH0707843Medicare PIN
OHOH3931OtherEYEMED