Wallace Lloyd Christensen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP0721 Issued in ID

Practice address

1246 Yellowstone Ave
Suite A4
Pocatello, ID 83201-4374

Phone

(208) 237-7666

Fax

(208) 237-7400

NPI assigned

May 18, 2006

Last updated

Oct 4, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vistec LLC

  • Optometrist
  • Pocatello, ID
  • NPI 1992198675
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380844800000",
    "number": "1760435143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 YELLOWSTONE AVE",
            "address_2": "SUITE A4",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014374",
            "telephone_number": "208-237-7666",
            "fax_number": "208-237-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 YELLOWSTONE AVE",
            "address_2": "SUITE A4",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014374",
            "telephone_number": "208-237-7666",
            "fax_number": "208-237-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTENSEN",
        "first_name": "WALLACE",
        "middle_name": "LLOYD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2013-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP0721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002875500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayloni C Christensen, NP
• Kelli Deanne Christensen, MD
• Matthew R Christensen, LCSW
• McKenzie Dawn Christensen, LCPC
• Natalie Chase Christensen, RDN, LD
• Channing Christiansen, DPT
• Melissa Christoffersen
• Venetta Jean Christopherson, PHARMD, CGP
• Christy Kelshaw
• McHale Chriswell

• Optometrist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.