Basic Information
| Provider Information | |||||||||
| NPI: | 1780796490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLAROSSI | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 5712236780 | ||||||||
| Practice Location | |||||||||
| Address1: | 616 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444602935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303322080 | ||||||||
| FaxNumber: | 3303322123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG003132 | PA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OET009007 | PA | N | Eye and Vision Services Providers | Optometrist | 152WX0102X | OPT006514 | OH | N | Eye and Vision Services Providers | Optometrist | Occupational Vision | 152W00000X | OPT006514 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.