Provider Demographics
NPI:1588757983
Name:JANSEN, TERENCE (OD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:
Last Name:JANSEN
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 1:104 E OLTORF ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5529
Mailing Address - Country:US
Mailing Address - Phone:512-442-2308
Mailing Address - Fax:512-445-4546
Practice Address - Street 1:104 E OLTORF ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5529
Practice Address - Country:US
Practice Address - Phone:512-442-2308
Practice Address - Fax:512-445-4546
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX3559152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management