Healthcare Provider Details

I. General information

NPI: 1639387509
Provider Name (Legal Business Name): CHRISTI WILLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CONN TER STE 550
LEXINGTON KY
40508-3206
US

IV. Provider business mailing address

304 ARCADIA PARK
LEXINGTON KY
40503-1313
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41751
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26852
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number4151
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: