Individual
DR. CHRISTINA MARIE MUMMERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
14413 ILLINOIS RD, SUITE C, FORT WAYNE, IN 46814-9714
(260) 616-0184
(855) 271-9517
Mailing address
14413 ILLINOIS RD, SUITE C, FORT WAYNE, IN 46814-9714
(260) 616-0184
(855) 271-9517
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003334A
IN
152W00000X
Optometrist
4901004071
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410029181
RR MEDICARE
IN
Enumeration date
10/10/2005
Last updated
12/16/2020
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