Provider Demographics
NPI:1073135109
Name:JENSEN, ALISON ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ELIZABETH
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 132ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2132
Mailing Address - Country:US
Mailing Address - Phone:425-214-3414
Mailing Address - Fax:
Practice Address - Street 1:112 PELLY AVE N
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5713
Practice Address - Country:US
Practice Address - Phone:425-255-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.61080336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist