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NPI Code Detail

MEDICARE: BRAD W. CHRISTOPHERSON OD

MEDICARE: BRAD W. CHRISTOPHERSON 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
1152W00000XOptometrist3119MN
2152W00000XOptometrist3119WI

General Provider Information

NPI Number : 1639332992
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD W. CHRISTOPHERSON OD
Provider Business Mailing Address
First Line : 4100 STATE HWY 66
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8410
Country : US
Telephone Number : 715-343-7760
Fax Number :
Provider Business Practice Location Address
First Line : 4100 STATE HWY 66
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8410
Country : US
Telephone Number : 715-343-7760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2008
Last Update Date : 05/08/2023

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