Basic Information
| Provider Information | |||||||||
| NPI: | 1346226560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSON | ||||||||
| FirstName: | GARTH | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 VINE ST | ||||||||
| Address2: | STE E | ||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540165802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153811234 | ||||||||
| FaxNumber: | 7153815357 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 VINE ST | ||||||||
| Address2: | STE E | ||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540165802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153811234 | ||||||||
| FaxNumber: | 7153815357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WP0200X | 1992-35 | WI | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | 1992-35 | WI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.