Provider Demographics
NPI:1366593162
Name:PALMER, CHRISTOPHER J (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:PALMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19515 JAMESTOWN ST NE
Mailing Address - Street 2:
Mailing Address - City:EAST BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8535
Mailing Address - Country:US
Mailing Address - Phone:612-423-4403
Mailing Address - Fax:
Practice Address - Street 1:6175 CAHILL AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-5501
Practice Address - Country:US
Practice Address - Phone:651-455-1492
Practice Address - Fax:651-455-9466
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU54490Medicare UPIN