Provider Demographics
NPI:1083924419
Name:CHRISTMAN, JENNIFER MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 WESTPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:KELOWNA
Mailing Address - State:BC
Mailing Address - Zip Code:V1W 2Z4
Mailing Address - Country:CA
Mailing Address - Phone:714-612-1725
Mailing Address - Fax:
Practice Address - Street 1:1098 ALDER AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4318
Practice Address - Country:US
Practice Address - Phone:360-659-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60172850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist