MEDICARE: DR. CHRISTEEN MIN O.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	152W00000X	Optometrist	35326	CA
2	152W00000X	Optometrist	TA2096	MD
3	152W00000X	Optometrist	0618001911	VA

General Provider Information

NPI Number	:	1275703068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTEEN MIN O.D.

Provider Business Mailing Address
First Line	:	27246 RED WILLOW CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-2171
Country	:	US
Telephone Number	:	703-314-8588
Fax Number	:

Provider Business Practice Location Address
First Line	:	27246 RED WILLOW CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-2171
Country	:	US
Telephone Number	:	703-314-8588
Fax Number	:

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

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	11/07/2022

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