Healthcare Provider Details

I. General information

NPI: 1336164896
Provider Name (Legal Business Name): TONY JAY JENSEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 NEVADA HWY
BOULDER CITY NV
89005-1908
US

IV. Provider business mailing address

1504 IRENE DR
BOULDER CITY NV
89005-3612
US

V. Phone/Fax

Practice location:
  • Phone: 702-294-2227
  • Fax: 702-293-3723
Mailing address:
  • Phone: 714-454-2627
  • Fax: 702-293-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number549
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: