Provider Demographics
NPI:1831272178
Name:MABRY, CHRISTINA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:MABRY
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 1:3075 HAMRICK RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2844
Mailing Address - Country:US
Mailing Address - Phone:541-734-2467
Mailing Address - Fax:541-734-0982
Practice Address - Street 1:3075 HAMRICK RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2844
Practice Address - Country:US
Practice Address - Phone:541-734-2467
Practice Address - Fax:541-734-0982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4034152W00000X
OR3124 AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR155697OtherPTAN
FLV06805Medicare UPIN
ORR155697OtherPTAN