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Provider Information for 1912990086

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

CHRISTOPHER W LIEVENS OD

Gender: MALE

Individual NPI: 1912990086

Calendar   Last Updated:  2013-04-17
  Certification Date: 

Details

Name Value
NPI 1912990086
Enumeration Date 2005-08-24
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1245 MADISON AVE
MEMPHIS, TN 38104-2211
United States

Phone: 701-722-3250 | Fax: 901-722-3347
View Map External Link
Primary Practice Address 1225 MADISON AVE
MEMPHIS, TN 38104-2211
United States

Phone: 701-722-3250 | Fax: 901-722-3347
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other DEA ML0699100
Other OD TN 2221
MEDICAID TN 3944123
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 152W00000X - Optometrist TN 2221