Individual provider Active NPI

Ross Anthony Jensen, O.D.

  • Optometrist
  • Appleton, WI
National Provider Identifier
1568758183
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3220-35 Issued in WI
Practice address
21 Park PL
Appleton, WI 54914-8872
Phone
(920) 739-4361
Fax
(920) 739-6368
NPI assigned
Jun 22, 2011
Last updated
Apr 5, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3220-35 WI Primary

Addresses

Primary practice location

21 Park PL
Appleton, WI 54914-8872

Mailing address

21 Park PL
Appleton, WI 54914-8872
Phone (262) 432-2005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110822000390 WI Practitioner - Optometry 7911177316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Eye AssociatesGroup PAC ID 5395633580, 25 clinicians

Practice addresses (Care Compare)

21 Park PL
Appleton, WI 54914-8872
Phone (920) 739-4361

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3220-35WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Eye Associates Optometrist CurrentSince Jun 1, 2016 Accepting new patients
Park Place Optical, LTD PastSince Jun 1, 2016 Accepting new patients

Locations

21 Park Pl
Appleton, WI 54914
Phone (920) 739-4361

2500 E Capitol Dr
Ste 3500
Appleton, WI 54911
Phone (920) 358-1820

4648 W Spencer St
Appleton, WI 54914
Phone (920) 731-7557

1543 Park Pl
Ste 400
Green Bay, WI 54304
Phone (920) 497-0100

Organizations & group practices 2

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": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1568758183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 PARK PL",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549148872",
            "telephone_number": "262-432-2005",
            "fax_number": "262-432-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 PARK PL",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549148872",
            "telephone_number": "920-739-4361",
            "fax_number": "920-739-6368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "ROSS",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3220-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.