Provider Demographics
NPI:1760536825
Name:CHRISTENSEN, TODD WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WILLIAM
Last Name:CHRISTENSEN
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 1:1551 VALLEY WEST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1112
Mailing Address - Country:US
Mailing Address - Phone:515-223-7215
Mailing Address - Fax:515-223-6333
Practice Address - Street 1:1551 VALLEY WEST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1112
Practice Address - Country:US
Practice Address - Phone:515-223-7215
Practice Address - Fax:515-223-6333
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0067439Medicaid
IA67393OtherCOVENTRY HEALTH CARE
IA910345OtherEYEMED
IA00938Medicare ID - Type Unspecified
IA0067439Medicaid
IAU03156Medicare UPIN