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General NPI Number Information
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NPI Number | 1881885309
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Entity Type | Organization
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Legal Business Name | MARK R CHRISTENSEN, O.D., INC., A PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 1710 PENNSYLVANIA AVE STE B
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City | FAIRFIELD
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State | CA
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Zip | 94533-3549
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Country | US
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Telephone | 707-425-2187
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Fax | 707-434-8130
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Provider Business Mailing Address
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Address Line | 1710 PENNSYLVANIA AVE STE B
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City | FAIRFIELD
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State | CA
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Zip | 94533-3549
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Country | US
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Telephone | 707-425-2187
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Fax | 707-434-8130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK R CHRISTENSEN
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Credential | O.D.
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Telephone | 707-425-2187
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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 | OPT 7874 TPA
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License Number State | CA
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