Provider Demographics
NPI:1407955255
Name:CHRISTENSEN EYECARE, PC
Entity Type:Organization
Organization Name:CHRISTENSEN EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-554-0109
Mailing Address - Street 1:1632 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8367
Mailing Address - Country:US
Mailing Address - Phone:801-779-3806
Mailing Address - Fax:801-779-3807
Practice Address - Street 1:1632 N 2000 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8367
Practice Address - Country:US
Practice Address - Phone:801-779-3806
Practice Address - Fax:801-779-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52813876001Medicaid
U55367Medicare UPIN
UT00090514Medicare ID - Type Unspecified