Healthcare Provider Details

I. General information

NPI: 1851033294
Provider Name (Legal Business Name): CHRISTIAN MILES ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 DAMON ST
EAU CLAIRE WI
54701-3899
US

IV. Provider business mailing address

2715 DAMON ST
EAU CLAIRE WI
54701-3899
US

V. Phone/Fax

Practice location:
  • Phone: 715-834-8471
  • Fax: 715-834-8471
Mailing address:
  • Phone: 715-834-8471
  • Fax: 715-834-8471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number86814-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: