Provider Demographics
NPI:1104887868
Name:HARTSFIELD, CHRISTIE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:MARIE
Last Name:HARTSFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E FLETCHER AVE
Mailing Address - Street 2:INSIDE FREY EYE DESIGNS
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3668
Mailing Address - Country:US
Mailing Address - Phone:813-977-4801
Mailing Address - Fax:813-979-4572
Practice Address - Street 1:1410 E FLETCHER AVE
Practice Address - Street 2:FREY EYE DESIGNS
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3668
Practice Address - Country:US
Practice Address - Phone:813-977-4801
Practice Address - Fax:813-979-4572
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62111860Medicaid
FLV05245Medicare PIN
FLU4880BMedicare UPIN