MEDICARE: DR. CHRISTOPHER JOHN RENNER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000112	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003868829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN RENNER O.D.

Provider Business Mailing Address
First Line	:	5653 COLUMBIA PIKE
Second Line	:	SUITE 101
City	:	BAILEYS CROSSROADS
State	:	VA
Zip	:	22041-2872
Country	:	US
Telephone Number	:	703-578-3600
Fax Number	:	703-379-6089

Provider Business Practice Location Address
First Line	:	5653 COLUMBIA PIKE
Second Line	:	SUITE 101
City	:	BAILEYS CROSSROADS
State	:	VA
Zip	:	22041-2872
Country	:	US
Telephone Number	:	703-578-3600
Fax Number	:	703-379-6089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/21/2009

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