Provider Demographics
NPI:1912190604
Name:JENSEN, KATHERINE BRAUSS (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BRAUSS
Last Name:JENSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:BRAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2301 WILTON DR
Mailing Address - Street 2:C-1
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1202
Mailing Address - Country:US
Mailing Address - Phone:954-764-6906
Mailing Address - Fax:954-463-7933
Practice Address - Street 1:2301 WILTON DR
Practice Address - Street 2:C-1
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1202
Practice Address - Country:US
Practice Address - Phone:954-764-6906
Practice Address - Fax:954-463-7933
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4114152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000J1OtherBCBSFL
FL621354500Medicaid
FL0227079OtherUNITEDHEALTHCARE
FL000J1OtherBCBSFL