Provider Demographics
NPI:1962560326
Name:DICKENS, CHRISTOPHER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:DICKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:491 30TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3235
Mailing Address - Country:US
Mailing Address - Phone:510-763-9775
Mailing Address - Fax:510-763-1501
Practice Address - Street 1:491 30TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3235
Practice Address - Country:US
Practice Address - Phone:510-763-9775
Practice Address - Fax:510-763-1501
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG52201207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G522010Medicaid
CA00G522010Medicaid
CA00G522011Medicare ID - Type Unspecified