Healthcare Provider Details

I. General information

NPI: 1699708503
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH BOSTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 N BROADWAY
PENNSVILLE NJ
08070-1754
US

IV. Provider business mailing address

48 N BROADWAY
PENNSVILLE NJ
08070-1754
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-4800
  • Fax: 610-695-9047
Mailing address:
  • Phone: 856-678-4800
  • Fax: 610-695-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG-000461
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: