Provider Demographics
NPI:1073287322
Name:CHRISTENSON, GRIFFIN (OD)
Entity Type:Individual
Prefix:DR
First Name:GRIFFIN
Middle Name:
Last Name:CHRISTENSON
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 1:2215 VINE ST STE E
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-5862
Mailing Address - Country:US
Mailing Address - Phone:715-381-1234
Mailing Address - Fax:
Practice Address - Street 1:2215 VINE ST STE E
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-5862
Practice Address - Country:US
Practice Address - Phone:715-381-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3697-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist