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NPI Code Detail

MEDICARE: GEORGIANN KAE JENSEN O.D.

MEDICARE: GEORGIANN KAE JENSEN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1994MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134272586
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGIANN KAE JENSEN O.D.
Provider Business Mailing Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Provider Business Practice Location Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 09/27/2010

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