Individual
NICOLE M. JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1200 W MAIN ST, STE 21, PEORIA, IL 61606-1200
(309) 672-2273
(309) 672-2274
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 693-9754
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.010457
IL
Other
Enumeration date
07/08/2011
Last updated
07/10/2014
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