Provider Demographics
NPI:1649501651
Name:S L CHRISTENSEN O D & ASSOC P C
Entity type:Organization
Organization Name:S L CHRISTENSEN O D & ASSOC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEDE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-820-2500
Mailing Address - Street 1:1321 N COLUMBIA CENTER BLVD STE 419
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7184
Mailing Address - Country:US
Mailing Address - Phone:509-820-2500
Mailing Address - Fax:509-491-1725
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:SUITE 419
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2455
Practice Address - Country:US
Practice Address - Phone:509-735-3022
Practice Address - Fax:509-736-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136315Medicare PIN