Healthcare Provider Details

I. General information

NPI: 1093728388
Provider Name (Legal Business Name): BRUCE ALLEN CHRISTENSEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH AVE
BATTLE CREEK MI
49017-3417
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-7595
  • Fax: 269-963-9202
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: