Provider Demographics
NPI:1427321504
Name:CHRISTOPHERSON, BRYCE ALAN (OD)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:ALAN
Last Name:CHRISTOPHERSON
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 1:341 KELLER AVE N
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1037
Mailing Address - Country:US
Mailing Address - Phone:715-268-2020
Mailing Address - Fax:715-268-5432
Practice Address - Street 1:341 KELLER AVE N
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1037
Practice Address - Country:US
Practice Address - Phone:715-268-2020
Practice Address - Fax:715-268-5432
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3253-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist