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General NPI Number Information
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NPI Number | 1912190604
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Entity Type | Individual
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Provider Name | KATHERINE BRAUSS JENSEN OD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2007
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 2301 WILTON DR C-1
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City | WILTON MANORS
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State | FL
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Zip | 33305-1202
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Country | US
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Telephone | 954-764-6906
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Fax | 954-463-7933
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Provider Business Mailing Address
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Address Line | 2301 WILTON DR C-1
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City | WILTON MANORS
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State | FL
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Zip | 33305-1202
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Country | US
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Telephone | 954-764-6906
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Fax | 954-463-7933
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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 | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | OPC4114
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4114
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License Number State | FL
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