MEDICARE: DR. JONATHAN MARK CHRISTIANSEN 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	550	NV

General Provider Information

NPI Number	:	1750306395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MARK CHRISTIANSEN O.D.

Provider Business Mailing Address
First Line	:	1196 BROCKLEY CROSS ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-3362
Country	:	US
Telephone Number	:	714-356-8451
Fax Number	:

Provider Business Practice Location Address
First Line	:	4485 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5029
Country	:	US
Telephone Number	:	702-737-0097
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/06/2012

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