Provider Demographics
NPI:1588732721
Name:CAVALLARO, CHRISTA J (OD)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:J
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4814 SKILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1026
Mailing Address - Country:US
Mailing Address - Phone:917-687-8153
Mailing Address - Fax:
Practice Address - Street 1:4814 SKILLMAN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1026
Practice Address - Country:US
Practice Address - Phone:917-687-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT5958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G400006449Medicare PIN
J400006149Medicare PIN
NY126791Medicare UPIN