Provider Demographics
NPI:1336213404
Name:CERWINKA, CHRISTIE (OD)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:CERWINKA
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 1:11103 WEST AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:11720 MEDLOCK BRIDGE RD
Practice Address - Street 2:STE. 140
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1509
Practice Address - Country:US
Practice Address - Phone:770-495-7898
Practice Address - Fax:770-495-7906
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist