Healthcare Provider Details

I. General information

NPI: 1588757983
Provider Name (Legal Business Name): TERENCE JANSEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E OLTORF ST
AUSTIN TX
78704-5529
US

IV. Provider business mailing address

104 E OLTORF ST
AUSTIN TX
78704-5529
US

V. Phone/Fax

Practice location:
  • Phone: 512-442-2308
  • Fax: 512-445-4546
Mailing address:
  • Phone: 512-442-2308
  • Fax: 512-445-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTX3559
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTX3559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: