Provider Demographics
NPI:1255432928
Name:GENERIE, CHRISTINA E (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:E
Last Name:GENERIE
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:E
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6230 OLD DOBBIN LN STE 190
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5954
Mailing Address - Country:US
Mailing Address - Phone:443-420-8113
Mailing Address - Fax:443-973-6998
Practice Address - Street 1:6230 OLD DOBBIN LN STE 190
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5954
Practice Address - Country:US
Practice Address - Phone:443-420-8113
Practice Address - Fax:443-973-6998
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA1997152W00000X
DCOP1000119152W00000X
MDTA1997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11625596OtherCAQH
MD11625596OtherCAQH
NYU64059Medicare UPIN
NY14107BMedicare ID - Type Unspecified