Basic Information
Provider Information
NPI: 1033106307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: DAVID
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 220 N MCKEMY AVE
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852262654
CountryCode: US
TelephoneNumber: 4809611865
FaxNumber: 4809614605
Practice Location
Address1: 2050 N ALMA SCHOOL RD
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852242887
CountryCode: US
TelephoneNumber: 4807861075
FaxNumber: 4807860476
Other Information
ProviderEnumerationDate: 10/03/2005
LastUpdateDate: 05/06/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X1018AZY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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