Provider Demographics
NPI:1063594547
Name:CHRISTENSEN, KATHLEEN M (OD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MAGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7100 KIT CREEK RD BLDG 9
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8663
Practice Address - Country:US
Practice Address - Phone:919-392-2002
Practice Address - Fax:919-590-6342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00078600152W00000X
NC2083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K5487OtherHEALTHNET
NJ5251729Medicaid
NJ5789545OtherAETNA
NJ5789545OtherAETNA
NJ5251729Medicaid