Provider Demographics
NPI:1740614866
Name:BOSTON, CHRISTOPHER MICHAEL I (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BOSTON
Suffix:I
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 1:7951 HOPEFUL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KENTUCKY
Mailing Address - Zip Code:41042
Mailing Address - Country:UM
Mailing Address - Phone:859-628-5186
Mailing Address - Fax:
Practice Address - Street 1:7951 HOPEFUL CHURCH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7922
Practice Address - Country:US
Practice Address - Phone:859-628-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1219156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician