MEDICARE: CHRISTOPHER THOMAS POLK OD

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
1	152W00000X	Optometrist	OPC6766	FL

General Provider Information

NPI Number	:	1215827597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER THOMAS POLK OD

Provider Business Mailing Address
First Line	:	113 N PALAFOX ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32502-4838
Country	:	US
Telephone Number	:	850-390-2121
Fax Number	:	850-695-3335

Provider Business Practice Location Address
First Line	:	770 US HIGHWAY 331 S STE 1
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-3358
Country	:	US
Telephone Number	:	850-892-5514
Fax Number	:	850-695-3335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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