Provider Demographics
NPI:1871679365
Name:WARD, CHRISTENA (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTENA
Middle Name:
Last Name:WARD
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:PO BOX 3728
Mailing Address - Street 2:324 US HWY 6 STE, M
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-3728
Mailing Address - Country:US
Mailing Address - Phone:970-262-9272
Mailing Address - Fax:970-262-7512
Practice Address - Street 1:324 US HWY 6, STE M
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435
Practice Address - Country:US
Practice Address - Phone:970-262-9272
Practice Address - Fax:970-262-7512
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4708220001Medicare NSC
COCO40774Medicare PIN