Provider Demographics
NPI:1033302161
Name:CHRISTENSEN, ROB DEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:DEE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3045 E ST LUKES ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3507
Mailing Address - Country:US
Mailing Address - Phone:208-433-1410
Mailing Address - Fax:208-433-1403
Practice Address - Street 1:1410 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3706
Practice Address - Country:US
Practice Address - Phone:208-433-1410
Practice Address - Fax:208-433-1403
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100054152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807022800Medicaid
ID807022800Medicaid
ID1594386Medicare PIN