Individual
RICHARD A JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00001958
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2033116
—
WA
01
—
5262JE
BLUE SHIELD #
WA
01
—
P00395658
RAILROAD MC#
WA
01
—
US7327863
AETNA PCP PIN
WA
Enumeration date
12/19/2006
Last updated
05/15/2008
Update your record
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