Provider Demographics
NPI:1124109608
Name:CHRISTENSEN, STEPHEN L (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
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 1:3911 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-9230
Mailing Address - Country:US
Mailing Address - Phone:480-861-7331
Mailing Address - Fax:480-755-3534
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:STE 419
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2455
Practice Address - Country:US
Practice Address - Phone:480-861-7331
Practice Address - Fax:480-755-3534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136316Medicare PIN