Provider Demographics
NPI:1750499240
Name:CHRISTIANSON, JEFFREY E (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:CHRISTIANSON
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 1:16800 WEST CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3533
Mailing Address - Country:US
Mailing Address - Phone:262-432-2005
Mailing Address - Fax:
Practice Address - Street 1:1837 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2860
Practice Address - Country:US
Practice Address - Phone:608-756-0728
Practice Address - Fax:608-756-0782
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2575-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38605400Medicaid
WI2575OtherEYEMED VISION NO.
WI2575OtherEYEMED VISION NO.