Provider Demographics
NPI:1306739958
Name:JENSEN, TRAVIS (OD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13361 HONEYSUCKLE WAY
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8204
Mailing Address - Country:US
Mailing Address - Phone:218-330-8227
Mailing Address - Fax:
Practice Address - Street 1:132 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1106
Practice Address - Country:US
Practice Address - Phone:320-983-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist