Provider Demographics
NPI:1992304331
Name:MOUSTOPOULOS, CHRISTINA (OD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MOUSTOPOULOS
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 1:655 BRANDON TOWN CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4770
Mailing Address - Country:US
Mailing Address - Phone:813-681-1036
Mailing Address - Fax:813-651-0964
Practice Address - Street 1:30715 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4400
Practice Address - Country:US
Practice Address - Phone:727-785-8645
Practice Address - Fax:727-786-8258
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty