Provider Demographics
NPI:1629108709
Name:HOWARD, CHRISTOPHER R (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:HOWARD
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 1:1005 S FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4509
Mailing Address - Country:US
Mailing Address - Phone:850-682-1859
Mailing Address - Fax:850-682-8674
Practice Address - Street 1:1005 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4509
Practice Address - Country:US
Practice Address - Phone:850-682-1859
Practice Address - Fax:850-682-8674
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3124152W00000X
ALS866TA408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EB882AOtherPTAN MEDICARE
FL20837OtherBLUE CROSS BLUE SHIELD
FL620311600Medicaid
FL20837OtherBLUE CROSS BLUE SHIELD
U69457Medicare UPIN