Provider Demographics
NPI:1184418667
Name:JENSEN, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 S STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6615
Mailing Address - Country:US
Mailing Address - Phone:480-892-0805
Mailing Address - Fax:480-890-0856
Practice Address - Street 1:1955 S STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6615
Practice Address - Country:US
Practice Address - Phone:480-892-0805
Practice Address - Fax:480-892-0856
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
AZLDO003371156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician