Provider Demographics
NPI:1639281355
Name:CHRISTENSEN, ROB MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:MATTHEW
Last Name:CHRISTENSEN
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 1:1911 ELBOW BND
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2941
Mailing Address - Country:US
Mailing Address - Phone:620-338-3949
Mailing Address - Fax:
Practice Address - Street 1:1905 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2304
Practice Address - Country:US
Practice Address - Phone:620-227-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS481222465OtherTAXPAYER ID
KS053992OtherBLUE CROSS BLUE SHIELD KS
KS053992OtherBLUE CROSS BLUE SHIELD KS
KS481222465OtherTAXPAYER ID