Provider Demographics
NPI:1205844966
Name:STENSOS, JASON JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:STENSOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:POBOX 207158 CLARKSON OPTOMETRY INC
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0001
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:9721 LYNDALE AVE SO
Practice Address - Street 2:OXBORO EYE CLINIC
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-884-8338
Practice Address - Fax:952-884-4599
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN542999600Medicaid
MN652T9STOtherBCBS
MS1340962OtherDEA