Provider Demographics
NPI:1942587589
Name:JENSEN, STEVEN T (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:T
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4203 N SHERIDAN RD
Mailing Address - Street 2:STE A1-4
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7171
Mailing Address - Country:US
Mailing Address - Phone:309-557-8679
Mailing Address - Fax:309-827-8027
Practice Address - Street 1:801 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5951
Practice Address - Country:US
Practice Address - Phone:309-686-0763
Practice Address - Fax:309-685-8809
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist