Healthcare Provider Details

I. General information

NPI: 1477690378
Provider Name (Legal Business Name): CHRISTOPHER PAUL UDINA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N STATE ST
CONCORD NH
03301-4038
US

IV. Provider business mailing address

PO BOX 32
ANDOVER NH
03216-0032
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2512
  • Fax: 603-225-3249
Mailing address:
  • Phone: 603-735-6060
  • Fax: 877-521-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0750
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: