Provider Demographics
NPI:1467587196
Name:JENSEN, VIVIAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:12600 DOUBLE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5556
Mailing Address - Country:US
Mailing Address - Phone:310-663-8278
Mailing Address - Fax:626-356-9326
Practice Address - Street 1:1400 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8515
Practice Address - Country:US
Practice Address - Phone:425-741-8937
Practice Address - Fax:626-357-3179
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2024-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA13199T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist