Provider Demographics
NPI:1730125477
Name:CHRISTENSEN, LAYNE R (OD)
Entity Type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:R
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:290 SIERRA COLLEGE DR STE C
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5762
Mailing Address - Country:US
Mailing Address - Phone:530-273-4451
Mailing Address - Fax:530-272-5408
Practice Address - Street 1:290 SIERRA COLLEGE DR STE C
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5762
Practice Address - Country:US
Practice Address - Phone:530-273-4451
Practice Address - Fax:530-272-5408
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0079370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079370Medicare PIN
CAT10622Medicare UPIN
0698480001Medicare NSC