Provider Demographics
NPI:1841360633
Name:JENSEN, KENT CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:CHARLES
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11703 HUEBNER RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1201
Mailing Address - Country:US
Mailing Address - Phone:210-764-7575
Mailing Address - Fax:210-764-7576
Practice Address - Street 1:11703 HUEBNER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1201
Practice Address - Country:US
Practice Address - Phone:210-764-7575
Practice Address - Fax:210-764-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3951TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
270049OtherMEDICARE PTAN
TX1841360633Medicare UPIN