Provider Demographics
NPI:1245066745
Name:WEBBER, CHRISTIAN (ABOC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:WEBBER
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LUNGER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8330
Mailing Address - Country:US
Mailing Address - Phone:570-387-5239
Mailing Address - Fax:570-387-5294
Practice Address - Street 1:100 LUNGER DR
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8330
Practice Address - Country:US
Practice Address - Phone:570-387-5239
Practice Address - Fax:570-387-5294
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty