MEDICARE: DR. SETH ALLEN JENSEN OD

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
1	152W00000X	Optometrist	342T	WY

General Provider Information

NPI Number	:	1598090672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH ALLEN JENSEN OD

Provider Business Mailing Address
First Line	:	3101 WYOMING BLVD SW
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-4543
Country	:	US
Telephone Number	:	307-265-7008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 WYOMING BLVD SW
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-4543
Country	:	US
Telephone Number	:	307-265-7008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	05/21/2020

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