Provider Demographics
NPI:1356418669
Name:CHRISTINE M. KNIFFEN, O.D., L.L.C.
Entity type:Organization
Organization Name:CHRISTINE M. KNIFFEN, O.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-265-3828
Mailing Address - Street 1:4306 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7751
Mailing Address - Country:US
Mailing Address - Phone:505-265-3828
Mailing Address - Fax:505-265-9684
Practice Address - Street 1:4306 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7751
Practice Address - Country:US
Practice Address - Phone:505-265-3828
Practice Address - Fax:505-265-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26155761Medicaid
NM338519002Medicare ID - Type Unspecified
NMV05498Medicare UPIN