Healthcare Provider Details

I. General information

NPI: 1396944773
Provider Name (Legal Business Name): BRIAN PETER JENSEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N TAYLOR ST
FALLON NV
89406
US

IV. Provider business mailing address

65 N TAYLOR ST
FALLON NV
89406
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-8024
  • Fax: 775-423-8593
Mailing address:
  • Phone: 775-423-8024
  • Fax: 775-423-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number581
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: