Provider Demographics
NPI:1780731885
Name:JENSEN, RONALD OWEN (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:OWEN
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 1:78015 MAIN ST
Mailing Address - Street 2:SUITE #107
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3420
Mailing Address - Country:US
Mailing Address - Phone:760-771-0715
Mailing Address - Fax:760-771-2033
Practice Address - Street 1:78015 MAIN ST
Practice Address - Street 2:SUITE #107
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3420
Practice Address - Country:US
Practice Address - Phone:760-771-0715
Practice Address - Fax:760-771-2033
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4972T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management