Provider Demographics
NPI:1821038233
Name:CHRISTIE, CHRISTINE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANN
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:BORGENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 9TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2329
Practice Address - Country:US
Practice Address - Phone:218-741-0150
Practice Address - Fax:218-741-7892
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821038233Medicaid
WI100098686Medicaid
MN2761OtherSTATE LICENSE