Provider Demographics
NPI:1932197506
Name:MARMO, CHRISTOPHER (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:MARMO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 W LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5924
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:21655 N LAKE PLEASANT PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7436
Practice Address - Country:US
Practice Address - Phone:623-537-4595
Practice Address - Fax:602-437-3498
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT001437152W00000X
AZOPT-001437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103957Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBERS
AZ103958Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBERS
AZT77692Medicare UPIN