Active NPI
Blake R Christensen, OD
- Optometrist
- Hewitt, TX
National Provider Identifier
1003803172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2919
- Practice address
- 512 Hewitt Dr
Hewitt, TX 76643-0296 - Phone
- (254) 666-2292
- NPI assigned
- Oct 4, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2919 | TX | Primary |
Addresses
Primary practice location
512 Hewitt Dr
Hewitt, TX 76643-0296
Mailing address
PO Box 296
Hewitt, TX 76643-0296
Phone (254) 666-2292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 093080202 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131105001028 | TX | Practitioner - Optometry | 5698900355 | Practice locations: Hewitt, TX |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2919 | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Temple Optometrists, P.C. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Temple, TX
- NPI 1932283710
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1003803172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 296",
"city": "HEWITT",
"state": "TX",
"postal_code": "766430296",
"telephone_number": "254-666-2292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "512 HEWITT DR",
"city": "HEWITT",
"state": "TX",
"postal_code": "766430296",
"telephone_number": "254-666-2292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTENSEN",
"first_name": "BLAKE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-04",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "2919",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "093080202",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hewitt, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.