Basic Information
| Provider Information | |||||||||
| NPI: | 1255490504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISAGIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O D P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7511 S MC CLINTOCK DRIVE | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809674910 | ||||||||
| FaxNumber: | 4809665992 | ||||||||
| Practice Location | |||||||||
| Address1: | 7511 S MC CLINTOCK DRIVE | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809674910 | ||||||||
| FaxNumber: | 4809665992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 10/18/2011 | ||||||||
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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 | AZ511 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.