Provider Demographics
NPI:1346226560
Name:CHRISTENSON, GARTH NEIL (OD)
Entity Type:Individual
Prefix:DR
First Name:GARTH
Middle Name:NEIL
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
Mailing Address - Street 2:STE E
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-5802
Mailing Address - Country:US
Mailing Address - Phone:715-381-1234
Mailing Address - Fax:715-381-5357
Practice Address - Street 1:2215 VINE ST
Practice Address - Street 2:STE E
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-5802
Practice Address - Country:US
Practice Address - Phone:715-381-1234
Practice Address - Fax:715-381-5357
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1992-35152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT97118Medicare UPIN
WI87646Medicare ID - Type Unspecified