Provider Demographics
NPI:1205921467
Name:EVANS, CHRISTOPHER CHARLES (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:EVANS
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 1:120 DISTRICT BLVD STE D109
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6304
Mailing Address - Country:US
Mailing Address - Phone:601-398-4662
Mailing Address - Fax:601-398-4669
Practice Address - Street 1:120 DISTRICT BLVD STE D109
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6304
Practice Address - Country:US
Practice Address - Phone:601-398-4662
Practice Address - Fax:601-398-4669
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04356376Medicaid
MS04356376Medicaid
MS410000318Medicare ID - Type Unspecified