Provider Demographics
NPI:1659932945
Name:CHRISTOPHERSON EYE CLINIC
Entity Type:Organization
Organization Name:CHRISTOPHERSON EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-268-2020
Mailing Address - Street 1:341 KELLER AVE N
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1037
Mailing Address - Country:US
Mailing Address - Phone:715-268-2020
Mailing Address - Fax:715-268-5432
Practice Address - Street 1:341 KELLER AVE N
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1037
Practice Address - Country:US
Practice Address - Phone:715-268-2020
Practice Address - Fax:715-268-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty