Healthcare Provider Details

I. General information

NPI: 1679311690
Provider Name (Legal Business Name): CHRISTINA BERNADETTE TANIOS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

798 E CHARING CROSS CIR
LAKE MARY FL
32746-3770
US

V. Phone/Fax

Practice location:
  • Phone: 407-314-2024
  • Fax:
Mailing address:
  • Phone: 407-314-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4034-35
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT.007401
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: