Provider Demographics
NPI:1669550786
Name:MONTGOMERY, CHRISTIANA VANZANT (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIANA
Middle Name:VANZANT
Last Name:MONTGOMERY
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 1:8104 CARRIAGE XING
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3263
Mailing Address - Country:US
Mailing Address - Phone:423-894-9974
Mailing Address - Fax:
Practice Address - Street 1:6150 POPLAR AVE STE 115
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4744
Practice Address - Country:US
Practice Address - Phone:901-682-3937
Practice Address - Fax:901-683-6172
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5543T152W00000X
TN1810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV02731Medicare UPIN