MEDICARE: DR. BLAKE R CHRISTENSEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2919	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003803172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE R CHRISTENSEN OD

Provider Business Mailing Address
First Line	:	PO BOX 296
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-0296
Country	:	US
Telephone Number	:	254-666-2292
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 HEWITT DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-0296
Country	:	US
Telephone Number	:	254-666-2292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/07/2013

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