Provider Demographics
NPI:1730125477
Name:CHRISTENSEN, LAYNE R (OD)
Entity type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:R
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2116 NEVADA CITY HWY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7702
Mailing Address - Country:US
Mailing Address - Phone:530-273-4451
Mailing Address - Fax:530-272-5408
Practice Address - Street 1:2116 NEVADA CITY HWY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7702
Practice Address - Country:US
Practice Address - Phone:530-273-4451
Practice Address - Fax:530-272-5408
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0079370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079370Medicare PIN
CAT10622Medicare UPIN
0698480001Medicare NSC