Healthcare Provider Details

I. General information

NPI: 1811362718
Provider Name (Legal Business Name): DR. ROBERT S. CHRISTENSEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CAMINO ALTO SUITE 110
MILL VALLEY CA
94941-1400
US

IV. Provider business mailing address

250 CAMINO ALTO SUITE 110
MILL VALLEY CA
94941-1400
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-3355
  • Fax:
Mailing address:
  • Phone: 415-381-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCA6009T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberCA6009T
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT SPENCER CHRISTENSEN
Title or Position: OWNER
Credential: O.D.
Phone: 415-381-3355