Individual
DR. WALLACE LLOYD CHRISTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1246 YELLOWSTONE AVE, SUITE A4, POCATELLO, ID 83201-4374
(208) 237-7666
(208) 237-7400
Mailing address
1246 YELLOWSTONE AVE, SUITE A4, POCATELLO, ID 83201-4374
(208) 237-7666
(208) 237-7400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP0721
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002875500
—
ID
Enumeration date
05/18/2006
Last updated
10/04/2013
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