Provider Demographics
NPI:1831353101
Name:JENSEN EYE CARE
Entity type:Organization
Organization Name:JENSEN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-265-7008
Mailing Address - Street 1:3101 WYOMING BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4543
Mailing Address - Country:US
Mailing Address - Phone:307-265-7008
Mailing Address - Fax:307-234-9405
Practice Address - Street 1:3101 WYOMING BLVD SW
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4543
Practice Address - Country:US
Practice Address - Phone:307-265-7008
Practice Address - Fax:307-234-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY166T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0803620001Medicare NSC
WYW302604Medicare PIN