Provider Demographics
NPI:1841341195
Name:LAYNE R. CHRISTENSEN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:LAYNE R. CHRISTENSEN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:LESSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-268-2020
Mailing Address - Street 1:290 SIERRA COLLEGE DR STE C
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5762
Mailing Address - Country:US
Mailing Address - Phone:530-260-2029
Mailing Address - Fax:530-268-2054
Practice Address - Street 1:10508 COMBIE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8908
Practice Address - Country:US
Practice Address - Phone:530-260-2029
Practice Address - Fax:530-268-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR3091Medicare PIN
CAZZZ04978ZMedicare PIN