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General NPI Number Information
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NPI Number | 1891935177
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Entity Type | Organization
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Legal Business Name | MARK J JENSEN OD PS
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 22530 SE 64TH PL SUITE 140
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City | ISSAQUAH
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State | WA
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Zip | 98027-8992
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Country | US
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Telephone | 425-392-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 22530 SE 64TH PL SUITE 140
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City | ISSAQUAH
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State | WA
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Zip | 98027-8992
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Country | US
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Telephone | 425-392-2020
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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. MARK J JENSEN
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Credential | O.D.
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Telephone | 425-392-2020
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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 | 1820
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License Number State | WA
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