Provider Demographics
NPI:1245301191
Name:HAJDUK, CHRISTINE DOROTHY (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DOROTHY
Last Name:HAJDUK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 S NEWKIRK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-1208
Mailing Address - Country:US
Mailing Address - Phone:215-336-2801
Mailing Address - Fax:
Practice Address - Street 1:1601 S COLUMBUS BLVD
Practice Address - Street 2:VISION CENTER IN WAL MART
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1402
Practice Address - Country:US
Practice Address - Phone:215-389-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008945152W00000X
GAOPT003613152W00000X
NJ27TO00067900152W00000X
NJ27OA00534600152W00000X
VA0618003167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01939054Medicaid