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General NPI Number Information
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NPI Number | 1871548669
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Entity Type | Organization
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Legal Business Name | JENSEN EYE ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 1615 12TH AVE RD STE A
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City | NAMPA
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State | ID
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Zip | 83686-7713
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Country | US
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Telephone | 208-467-3271
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Fax | 208-467-4450
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Provider Business Mailing Address
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Address Line | 1615 12TH AVE RD STE A
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City | NAMPA
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State | ID
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Zip | 83686-6184
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Country | US
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Telephone | 208-467-3271
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Fax | 208-467-4450
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Authorized Official
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Title or Position | OWNER
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Name | PETER E JENSEN
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Credential | M.D.
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Telephone | 208-467-3271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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