Provider Demographics
NPI:1427188218
Name:JENSEN, ANDREW JOSHUA (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSHUA
Last Name:JENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9080 KIMBERLY BLVD
Mailing Address - Street 2:STE #11
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2862
Mailing Address - Country:US
Mailing Address - Phone:561-488-6200
Mailing Address - Fax:561-488-0714
Practice Address - Street 1:9080 KIMBERLY BLVD
Practice Address - Street 2:STE #11
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2862
Practice Address - Country:US
Practice Address - Phone:561-488-6200
Practice Address - Fax:561-488-0714
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2682152W00000X
FLOPC4228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist