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General NPI Number Information
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NPI Number | 1982611745
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Entity Type | Individual
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Provider Name | CHRISTOPHER DAVID THEODOROFF O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 28825 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-4128
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Country | US
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Telephone | 586-573-0470
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Fax | 586-573-0648
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Provider Business Mailing Address
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Address Line | 61656 SPRING CIRCLE TRL
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City | WASHINGTON TOWNSHIP
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State | MI
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Zip | 48094-1143
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Country | US
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Telephone | 248-656-3292
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003333
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License Number State | MI
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