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General NPI Number Information
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NPI Number | 1841787603
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Entity Type | Individual
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Provider Name | CHRISTIAN MICHAEL PONDER D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1800 RENAISSANCE BLVD
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City | EDMOND
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State | OK
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Zip | 73013-3023
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Country | US
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Telephone | 405-359-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 16315 N MAY AVE
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City | EDMOND
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State | OK
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Zip | 73013-8892
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Country | US
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Telephone | 405-521-0041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 8414
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 8414
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License Number State | OK
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