Healthcare Provider Details

I. General information

NPI: 1154319010
Provider Name (Legal Business Name): CHRISTOPHER DAVID RADIG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N MAIN ST
POCAHONTAS IA
50574-1626
US

IV. Provider business mailing address

330 N MAIN ST
POCAHONTAS IA
50574-1626
US

V. Phone/Fax

Practice location:
  • Phone: 712-335-3298
  • Fax: 712-335-3262
Mailing address:
  • Phone: 712-335-3298
  • Fax: 712-335-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02036
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: