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General NPI Number Information
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NPI Number | 1811036056
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Entity Type | Individual
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Provider Name | CANDACE CHRISTEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1212 SANDY LN
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City | MONTICELLO
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State | MN
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Zip | 55362-8968
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Country | US
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Telephone | 612-310-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 SANDY LN
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City | MONTICELLO
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State | MN
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Zip | 55362-8968
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Country | US
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Telephone | 612-310-2203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2960
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3269
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TPOP48
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2880
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3498-35
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License Number State | WI
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