Provider Demographics
NPI:1194865063
Name:CHRISTENSON, JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:CHRISTENSON
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 1:2555 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3818
Mailing Address - Country:US
Mailing Address - Phone:734-995-4277
Mailing Address - Fax:734-995-0073
Practice Address - Street 1:2555 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3818
Practice Address - Country:US
Practice Address - Phone:734-995-4277
Practice Address - Fax:734-995-0073
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU50779Medicare UPIN
MIN26930175Medicare PIN