Provider Demographics
NPI:1902995418
Name:CHRISTIANSON, OWEN GARY (OD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:GARY
Last Name:CHRISTIANSON
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 1:1059 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3153
Mailing Address - Country:US
Mailing Address - Phone:320-587-4744
Mailing Address - Fax:320-587-9168
Practice Address - Street 1:1059 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3153
Practice Address - Country:US
Practice Address - Phone:320-587-4744
Practice Address - Fax:320-587-9168
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP20991OtherHEALTH PARTNERS
836689OtherARAZ
MN965301001126OtherPREFERRED ONE
FM115399OtherU-CARE
3C298CHOtherBCBS
MN2228812OtherMEDICA
MNT65399Medicare UPIN