Provider Demographics
NPI:1801408422
Name:CRESPO, CHRISTIAN EFRAIN (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:EFRAIN
Last Name:CRESPO
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 1:400 PERRINE RD STE 400B
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2811
Mailing Address - Country:US
Mailing Address - Phone:732-727-7450
Mailing Address - Fax:
Practice Address - Street 1:400 PERRINE RD STE 400B
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2811
Practice Address - Country:US
Practice Address - Phone:732-727-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist