Provider Demographics
NPI:1619530524
Name:WHEATON, CHRISTOPHER MORGAN (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MORGAN
Last Name:WHEATON
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WASHINGTON AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2618
Mailing Address - Country:US
Mailing Address - Phone:203-241-1799
Mailing Address - Fax:207-221-9302
Practice Address - Street 1:93 WASHINGTON AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2618
Practice Address - Country:US
Practice Address - Phone:207-730-6404
Practice Address - Fax:207-221-9302
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6347156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician