Individual
DR. GARY L JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 NW FIRST AVE, CHISHOLM, MN 55719-1811
(218) 254-4393
(218) 254-5471
Mailing address
11 NW FIRST AVE, CHISHOLM, MN 55719-1811
(218) 254-4393
(218) 254-5471
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1610
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01020509
BOIS PREFERRED ONE PIN
—
01
—
0150730001
ADMINISTAR FEDERAL(DMERC), INC.
—
01
—
2100694
MDMA3 MEDICA PIN
—
01
—
2200980
MCCS1 MEDICA PIN
—
01
—
2200981
MDMA2 MEDICA PIN
—
01
—
411260738
PABS CLARITY VISION PIN
—
01
—
524223100
MNMA MN MED ASSIST PIN
—
01
—
OD327JE
BCMA BCBS PIN
—
Enumeration date
07/13/2006
Last updated
01/05/2010
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