Provider Demographics
NPI:1932324944
Name:JENSEN, RYAN M (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
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 1:6944 A ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4112
Mailing Address - Country:US
Mailing Address - Phone:402-483-2444
Mailing Address - Fax:402-483-0022
Practice Address - Street 1:6944 A ST
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4112
Practice Address - Country:US
Practice Address - Phone:402-483-2444
Practice Address - Fax:402-483-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NET40326Medicare UPIN
NE096341Medicare ID - Type Unspecified