Healthcare Provider Details

I. General information

NPI: 1013832807
Provider Name (Legal Business Name): ISABELLA JENSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 7200 S
MIDVALE UT
84047-3723
US

IV. Provider business mailing address

20 W 7200 S
MIDVALE UT
84047-3723
US

V. Phone/Fax

Practice location:
  • Phone: 801-561-1300
  • Fax:
Mailing address:
  • Phone: 801-561-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14293521-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: