Provider Demographics
NPI:1932416708
Name:CHRISTENSEN, DANETTE DIANE (OPTICIAN)
Entity Type:Individual
Prefix:MISS
First Name:DANETTE
Middle Name:DIANE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ASSOCIATE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2266
Mailing Address - Country:US
Mailing Address - Phone:607-433-6433
Mailing Address - Fax:
Practice Address - Street 1:1 ASSOCIATE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2266
Practice Address - Country:US
Practice Address - Phone:607-433-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006760156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician