Provider Demographics
NPI:1295426245
Name:JENSEN, LISA KRISTINE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KRISTINE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 NW NEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9478
Mailing Address - Country:US
Mailing Address - Phone:541-505-4540
Mailing Address - Fax:
Practice Address - Street 1:300 NW OAK TREE LN
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1694
Practice Address - Country:US
Practice Address - Phone:541-923-7273
Practice Address - Fax:541-923-7468
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician