Provider Demographics
NPI:1225072036
Name:CHRISTENSEN, ELIZABETH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:CHRISTENSEN
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:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-0275
Mailing Address - Country:US
Mailing Address - Phone:858-756-3210
Mailing Address - Fax:858-756-3910
Practice Address - Street 1:6037 LA GRANADA AVE
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067-0275
Practice Address - Country:US
Practice Address - Phone:858-756-3210
Practice Address - Fax:858-756-3910
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7767T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP7767Medicare ID - Type Unspecified
U20570Medicare UPIN