Provider Demographics
NPI:1962054494
Name:TOM, CHRISTOPHER JONATHAN (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JONATHAN
Last Name:TOM
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 1:379 POMPANO CIR
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1903
Mailing Address - Country:US
Mailing Address - Phone:650-281-5841
Mailing Address - Fax:
Practice Address - Street 1:7361 W LAKE MEAD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1040
Practice Address - Country:US
Practice Address - Phone:702-877-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist