Provider Demographics
NPI:1689971673
Name:CLYMER, CHRISTINA BLANDON (ABOC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:BLANDON
Last Name:CLYMER
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BLANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COA, ABOC, NCLE
Mailing Address - Street 1:21122 LARSON RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-3522
Mailing Address - Country:US
Mailing Address - Phone:573-596-0048
Mailing Address - Fax:
Practice Address - Street 1:4430 MISSOURI AVE # 1263
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-9098
Practice Address - Country:US
Practice Address - Phone:573-596-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1202X
MO170167156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician