Provider Demographics
NPI:1811036056
Name:CHRISTEN, CANDACE (OD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:CHRISTEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8968
Mailing Address - Country:US
Mailing Address - Phone:612-310-2203
Mailing Address - Fax:
Practice Address - Street 1:1212 SANDY LN
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8968
Practice Address - Country:US
Practice Address - Phone:612-310-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2960152W00000X
CT3269152W00000X
FLTPOP48152W00000X
MDTA2880152W00000X
WI3498-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMN2960OtherSTATE LICENSE
MN22-04250OtherMEDICA, JCP LOCATION
MN2960OtherLICENSE
MN538K5CHOtherBCBS OF MN
MN22-04249OtherMEDICA, MACY'S LOCATION
MN221006OtherEYEMED
FLTPOP48OtherSTATE LICENSE
WI3498-35OtherLICENSE
WI3498-35OtherSTATE LICENSE
MN560-131-200Medicaid