Provider Demographics
NPI:1841392412
Name:OLDHAM, CHRISTOPHER RAYMOND (OD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RAYMOND
Last Name:OLDHAM
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 1:103 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3803
Mailing Address - Country:US
Mailing Address - Phone:508-481-4900
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3803
Practice Address - Country:US
Practice Address - Phone:508-481-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist