Provider Demographics
NPI:1144467424
Name:CHRISTENSEN OPTOMETRY A PROFESSIONAL LIMITED LIABILITY COM
Entity type:Organization
Organization Name:CHRISTENSEN OPTOMETRY A PROFESSIONAL LIMITED LIABILITY COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-657-0061
Mailing Address - Street 1:11223 TRENT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4005
Mailing Address - Country:US
Mailing Address - Phone:801-657-0061
Mailing Address - Fax:
Practice Address - Street 1:1905 S 300 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1806
Practice Address - Country:US
Practice Address - Phone:801-478-2745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7044278-9934302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization