MEDICARE: MRS. CHRISTINA MARIE PERSONIUS OD

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	OEG000707	PA
2	152W00000X	Optometrist	4094	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00080142	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2927764	OTHER	PA	AETNA
2	PA0707	OTHER	PA	EYE MED
4	PE 1313911	OTHER	PA	BC BS
5	217381	OTHER		COLE

General Provider Information

NPI Number	:	1578536041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA MARIE PERSONIUS OD

Provider Business Mailing Address
First Line	:	3921 W LINCOLN HWY
Second Line	:
City	:	DOWNINGTOWN
State	:	PA
Zip	:	19335-5502
Country	:	US
Telephone Number	:	610-269-9595
Fax Number	:	610-269-9613

Provider Business Practice Location Address
First Line	:	3921 W LINCOLN HWY
Second Line	:
City	:	DOWNINGTOWN
State	:	PA
Zip	:	19335-5502
Country	:	US
Telephone Number	:	610-269-9595
Fax Number	:	610-269-9613

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	09/27/2007

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