=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205844966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON JAMES STENSOS OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9721 LYNDALE AVE SO OXBORO EYE CLINIC
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-884-8338
-----------------------------------------------------
Fax | 952-884-4599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POBOX 207158 CLARKSON OPTOMETRY INC
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75320-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-200-4393
-----------------------------------------------------
Fax | 636-527-0766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3033
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------