Healthcare Provider Details

I. General information

NPI: 1235145764
Provider Name (Legal Business Name): CHRISTINE JACQUELINE KANTOR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 W PUTNAM AVE
GREENWICH CT
06830-5300
US

IV. Provider business mailing address

41 W PUTNAM AVE
GREENWICH CT
06830-5300
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-2255
  • Fax: 203-869-0333
Mailing address:
  • Phone: 203-869-2255
  • Fax: 203-869-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTPOP54
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2799
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00624600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number21338-875
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003056
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003769
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3876-35
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004568A
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007357
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV007056
License Number StateNY
# 11
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number002697
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: