Provider Demographics
NPI:1528063963
Name:COLVIN, CHRISTOPHER W (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:COLVIN
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 1:420 SINTZ ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504
Mailing Address - Country:US
Mailing Address - Phone:937-322-3871
Mailing Address - Fax:937-399-2346
Practice Address - Street 1:1674 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2652
Practice Address - Country:US
Practice Address - Phone:937-399-4101
Practice Address - Fax:937-399-2346
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201143OtherUNITED HEALTH CARE
OH0995240Medicaid
OH200806361027OtherCARESOURCE
OH11308OtherCORDINATED VISION CARE
OH4669244OtherAETNA
OH000000340281OtherANTHEM
OH4669244OtherAETNA
OH11308OtherCORDINATED VISION CARE