Provider Demographics
NPI:1700895836
Name:CAMUS, CHRISTIAN J (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:J
Last Name:CAMUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:JOSEPH
Other - Last Name:CAMUS
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:915 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3994
Practice Address - Country:US
Practice Address - Phone:262-569-2300
Practice Address - Fax:262-569-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2620-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38595400Medicaid
MC0181014OtherDEA NUMBER
WI38595400Medicaid
68080Medicare ID - Type UnspecifiedMEDICARE PROVIDER