Provider Demographics
NPI:1255998308
Name:AMBROSE, CHRISTOPHER ALEXANDER (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALEXANDER
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:ALEXANDER
Other - Last Name:AMBROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:101 NW 1ST ST STE 104
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1220
Mailing Address - Country:US
Mailing Address - Phone:812-618-4330
Mailing Address - Fax:
Practice Address - Street 1:101 NW 1ST ST STE 112
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1259
Practice Address - Country:US
Practice Address - Phone:812-426-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004155B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist