Provider Demographics
NPI:1588776785
Name:CHRISTMAN, DOUGLAS MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:CHRISTMAN
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 1:976 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1887
Mailing Address - Country:US
Mailing Address - Phone:276-638-2425
Mailing Address - Fax:276-638-2445
Practice Address - Street 1:976 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1887
Practice Address - Country:US
Practice Address - Phone:276-638-2425
Practice Address - Fax:276-638-2445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9230769Medicaid
U79322Medicare UPIN