Basic Information
| Provider Information | |||||||||
| NPI: | 1013271204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELLEJERA | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | US NAVAL HOSPITAL GUAM | ||||||||
| Address2: | PSC 455 BOX 208 | ||||||||
| City: | FPO, AP | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6713449679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTHELLO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993441040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094885256 | ||||||||
| FaxNumber: | 5094889939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OD60293859 | WA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.