Provider Demographics
NPI:1457446155
Name:MORTENSON, CHRISTIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:M
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:702 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1269
Mailing Address - Country:US
Mailing Address - Phone:484-824-1056
Mailing Address - Fax:
Practice Address - Street 1:1631 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6507
Practice Address - Country:US
Practice Address - Phone:717-391-7660
Practice Address - Fax:717-391-7663
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist