Provider Demographics
NPI:1912968819
Name:CHRISTENSEN, BRIAN TODD (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TODD
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 1:1360 E HERNDON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:
Practice Address - Street 1:1360 E HERNDON AVE STE 401
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9973T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004052Medicaid
CASD0099730Medicaid
CAGSD004053Medicaid
CAGSD004054Medicaid
CAGSD004050Medicaid
CAGSD004051Medicaid
CAGSD004053Medicaid
CASD0099730Medicaid
CAGSD004054Medicaid
CASD0099732Medicare PIN
CAU60350Medicare UPIN
CASD0099731Medicare PIN