Provider Demographics
NPI:1619669009
Name:JENSEN, HENRY ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ROBERT
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 N PIMA RD STE 155
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4483
Mailing Address - Country:US
Mailing Address - Phone:480-278-7732
Mailing Address - Fax:480-302-8703
Practice Address - Street 1:8415 N PIMA RD STE 155
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4483
Practice Address - Country:US
Practice Address - Phone:480-278-7732
Practice Address - Fax:480-302-8703
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist