Individual
RICHARD A JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1100 9TH AVE, MS C4-OPT, SEATTLE, WA 98101-2756
(206) 223-6840
(206) 515-5886
Mailing address
1100 OLIVE WAY, MS M4-PA, SEATTLE, WA 98101-1873
(206) 515-5811
(206) 515-5886
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
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