Provider Demographics
NPI:1063440832
Name:CHRISTIANSEN, JAMES RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:CHRISTIANSEN
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 1:29890 SW TOWN CENTER LOOP W
Mailing Address - Street 2:STE E
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9461
Mailing Address - Country:US
Mailing Address - Phone:503-682-3234
Mailing Address - Fax:503-682-0414
Practice Address - Street 1:29890 SW TOWN CENTER LOOP W
Practice Address - Street 2:STE E
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9461
Practice Address - Country:US
Practice Address - Phone:503-682-3234
Practice Address - Fax:503-682-0414
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2750AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU91763Medicare UPIN
ORR117938Medicare ID - Type Unspecified