Individual
DR. CHRISTOPHER DAVID THEODOROFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
28825 RYAN RD, WARREN, MI 48092-4128
(586) 573-0470
(586) 573-0648
Mailing address
61656 SPRING CIRCLE TRL, WASHINGTON TOWNSHIP, MI 48094-1143
(248) 656-3292
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003333
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1314720001
NSC
MI
05
—
2674552
—
MI
05
—
5189669
—
MI
05
—
5189678
—
MI
01
—
900E066750
BCBS
MI
Enumeration date
08/02/2006
Last updated
07/10/2008
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