Individual
DR. CHRISTA MARIE WIDJAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
5900 COIT RD, PLANO, TX 75023-5959
(972) 985-1412
Mailing address
5900 COIT RD, PLANO, TX 75023-5959
(972) 985-1412
(972) 945-2125
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9933
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4215477
—
TX
Enumeration date
07/30/2020
Last updated
10/05/2021
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