1073885232 NPI number — MR. CHRISTOPHER ANTONINI B.C.O.

Table of content: MR. CHRISTOPHER ANTONINI B.C.O. (NPI 1073885232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073885232 NPI number — MR. CHRISTOPHER ANTONINI B.C.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTONINI
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
B.C.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073885232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ANTONINI OCULAR PROSTHETICS, LLC
Provider Second Line Business Mailing Address:
1408 FAR MEADOWS
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-594-0719
Provider Business Mailing Address Fax Number:
364-241-1858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ANTONINI OCULAR PROSTHETICS, LLC
Provider Second Line Business Practice Location Address:
WVU EYE INSTITUTE, 1 MEDICAL CENTER DRIVE
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-594-0719
Provider Business Practice Location Address Fax Number:
304-241-1858
Provider Enumeration Date:
02/03/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 381002299 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".