Provider Demographics
NPI:1922030311
Name:DOSTAL, CHRISTOPHER JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:DOSTAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:40 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3100
Mailing Address - Country:US
Mailing Address - Phone:413-584-6422
Mailing Address - Fax:413-584-4346
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3100
Practice Address - Country:US
Practice Address - Phone:413-584-6422
Practice Address - Fax:413-584-4346
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0323748Medicaid
MAW17330Medicare ID - Type Unspecified
MA0323748Medicaid