Provider Demographics
NPI:1881227957
Name:CHRISTENSEN, ALEX (OD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W PRESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4838
Mailing Address - Country:US
Mailing Address - Phone:254-733-7476
Mailing Address - Fax:
Practice Address - Street 1:515 W BUCKEYE RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-3699
Practice Address - Country:US
Practice Address - Phone:602-207-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9884T152W00000X
AZ2444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist