MEDICARE: MR. ROBERT MERRILL CHRISTIANSEN M.D.

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	207W00000X	Ophthalmology Physician	168534-1205	UT

General Provider Information

NPI Number	:	1114991841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MERRILL CHRISTIANSEN M.D.

Provider Business Mailing Address
First Line	:	DEPARTMENT OF OPHTHALMOLOGY
Second Line	:	PO BOX 413075
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3075
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	U OF U DEPARTMENT OF OPHTHALMOLOGY MORAN EYE CTR
Second Line	:	65 MARIO CAPECCHI DRIVE
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0005
Country	:	US
Telephone Number	:	801-581-2352
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	11/12/2021

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