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General NPI Number Information
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NPI Number | 1306739958
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Entity Type | Individual
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Provider Name | TRAVIS JENSEN OD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 132 2ND AVE SW
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City | MILACA
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State | MN
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Zip | 56353-1106
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Country | US
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Telephone | 320-983-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 13361 HONEYSUCKLE WAY
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City | BAXTER
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State | MN
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Zip | 56425-8204
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Country | US
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Telephone | 218-330-8227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4003
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License Number State | MN
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