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NPI Code Detail

MEDICARE: VANESSA TILLEY CHRISTOPHERSON OD PLLC

MEDICARE: VANESSA TILLEY CHRISTOPHERSON OD PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist6883TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184916389
Entity Type Code : Organization
Provider Name (Legal Business Name) : VANESSA TILLEY CHRISTOPHERSON OD PLLC
Provider Business Mailing Address
First Line : 6419 SKILLMAN ST
Second Line :
City : DALLAS
State : TX
Zip : 75231-7109
Country : US
Telephone Number : 214-503-0997
Fax Number :
Provider Business Practice Location Address
First Line : 6419 SKILLMAN ST
Second Line :
City : DALLAS
State : TX
Zip : 75231-7109
Country : US
Telephone Number : 214-503-0997
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST/PRESIDENT
Name : DR. VANESSA TILLEY CHRISTOPHERSON
Credential : O.D.
Telephone Number : 214-503-0997
Provider Enumeration Date : 05/05/2011
Last Update Date : 03/01/2012

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