Provider Demographics
NPI:1154319010
Name:RADIG, CHRISTOPHER DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:RADIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1626
Mailing Address - Country:US
Mailing Address - Phone:712-335-3298
Mailing Address - Fax:712-335-3262
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1626
Practice Address - Country:US
Practice Address - Phone:712-335-3298
Practice Address - Fax:712-335-3262
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410038847OtherMEDICARE- RAILROAD
IA0113340Medicaid
0416820001OtherDMERC
0416820002OtherDMERC
IA1113340Medicaid
IA2113340Medicaid
0416820003OtherDMERC
IA2113340Medicaid
0416820002OtherDMERC
19383Medicare ID - Type Unspecified
16924Medicare ID - Type Unspecified