Provider Demographics
NPI:1679794960
Name:THAXTON, CHRISTOPHER DAVID (LDO, ABO, NCLEC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:THAXTON
Suffix:
Gender:M
Credentials:LDO, ABO, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 DONNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3821
Mailing Address - Country:US
Mailing Address - Phone:919-279-0888
Mailing Address - Fax:
Practice Address - Street 1:1838 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7415
Practice Address - Country:US
Practice Address - Phone:919-442-2506
Practice Address - Fax:919-442-2507
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2136156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2136OtherLICENSED OPTICIAN