Provider Demographics
NPI:1740405562
Name:THORSLAND, CHRISTOPHER MARK (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:THORSLAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:7367 SW BRIDGEPORT RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7710
Mailing Address - Country:US
Mailing Address - Phone:503-372-5013
Mailing Address - Fax:503-430-0951
Practice Address - Street 1:7367 SW BRIDGEPORT RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7710
Practice Address - Country:US
Practice Address - Phone:503-372-5013
Practice Address - Fax:503-430-0951
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3126 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist