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General NPI Number Information
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NPI Number | 1073808077
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Entity Type | Organization
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Legal Business Name | JENSEN EYECARE, INC
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 08/14/2016
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Provider Practice Location Address
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Address Line | 2970 NE 15TH TER
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City | OAKLAND PARK
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State | FL
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Zip | 33334-4410
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Country | US
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Telephone | 954-610-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 2970 NE 15TH TERRACE
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City | OAKLAND PARK
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State | FL
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Zip | 33334
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Country | US
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Telephone | 954-610-5927
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW JENSEN
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Credential | O.D.
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Telephone | 954-610-5927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4228
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License Number State | FL
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