Provider Demographics
NPI:1053519074
Name:WELSH, CHRISTINA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WELSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:ZORZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:24 E RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3619
Mailing Address - Country:US
Mailing Address - Phone:312-781-6035
Mailing Address - Fax:312-443-1921
Practice Address - Street 1:24 E RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3619
Practice Address - Country:US
Practice Address - Phone:312-781-6035
Practice Address - Fax:312-443-1921
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist