Individual provider Active NPI

Christopher Angelo Anastasiou, O.D

  • Optometrist
  • Philadelphia, PA
National Provider Identifier
1962417378
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG0001653 Issued in PA
Practice address
3419 Walnut St
Philadelphia, PA 19104-3410
Phone
(215) 386-5953
Fax
(215) 386-3508
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG0001653 PA Primary

Addresses

Primary practice location

3419 Walnut St
Philadelphia, PA 19104-3410

Mailing address

3419 Walnut St
Philadelphia, PA 19104-3410
Phone (215) 386-5953

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081013000434 PA Practitioner - Optometry 7416025812 Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG0001653PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Eye Inc Optometrist PastSince Jul 23, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1962417378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3419 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043410",
            "telephone_number": "215-386-5953",
            "fax_number": "215-386-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3419 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043410",
            "telephone_number": "215-386-5953",
            "fax_number": "215-386-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANASTASIOU",
        "first_name": "CHRISTOPHER",
        "middle_name": "ANGELO",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG0001653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.