Provider Demographics
NPI:1639332992
Name:CHRISTOPHERSON, BRAD W (OD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:W
Last Name:CHRISTOPHERSON
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 1:4100 STATE HWY 66
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8410
Mailing Address - Country:US
Mailing Address - Phone:715-343-7760
Mailing Address - Fax:
Practice Address - Street 1:4100 STATE HWY 66
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8410
Practice Address - Country:US
Practice Address - Phone:715-343-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3119152W00000X
WI3119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist