Provider Demographics
NPI:1689645723
Name:MAYER, CHRISTINE LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:MAYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2581 NUT TREE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6915
Mailing Address - Country:US
Mailing Address - Phone:707-447-1332
Mailing Address - Fax:707-447-4894
Practice Address - Street 1:2581 NUT TREE RD
Practice Address - Street 2:SUITE C
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6915
Practice Address - Country:US
Practice Address - Phone:707-447-1332
Practice Address - Fax:707-447-4894
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070040Medicaid
CA5417820002Medicare NSC
CASD0070042Medicare PIN
T10450Medicare UPIN
CASD0070040Medicaid
CA5417820001Medicare NSC