Basic Information
| Provider Information | |||||||||
| NPI: | 1932321460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NILSON | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 E 1400 N STE P | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843412450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357522020 | ||||||||
| FaxNumber: | 4357525475 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 E 1400 N STE P | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843412450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357522020 | ||||||||
| FaxNumber: | 4357525475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 6962612-1205 | UT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.