Individual provider Active NPI

Richard A Jensen, OD

  • Optometrist
  • Seattle, WA
National Provider Identifier
1447313234
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00001958 Issued in WA
Practice address
1100 9TH Ave
Ms C4-Opt
Seattle, WA 98101-2756
Phone
(206) 223-6840
Fax
(206) 515-5886
NPI assigned
Dec 19, 2006
Last updated
May 15, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00001958 WA Primary

Addresses

Primary practice location

1100 9TH Ave
Ms C4-Opt
Seattle, WA 98101-2756

Mailing address

1100 Olive Way
Ms M4-PA
Seattle, WA 98101-1873
Phone (206) 515-5811

Other identifiers 4

IdentifierTypeStateIssuer
P00395658OtherWARAILROAD MC#
US7327863OtherWAAETNA PCP PIN
5262JEOtherWABLUE SHIELD #
2033116MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD00001958WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Mason Medical Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: richard.jensen@direct.vmmc.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1447313234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 OLIVE WAY",
            "address_2": "MS M4-PA",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011873",
            "telephone_number": "206-515-5811",
            "fax_number": "206-515-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "address_2": "MS C4-OPT",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-223-6840",
            "fax_number": "206-515-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MC#",
            "identifier": "P00395658",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PCP PIN",
            "identifier": "US7327863",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD #",
            "identifier": "5262JE",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2033116",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.