Active NPI
Mark J Jensen, OD
- Optometrist
- Issaquah, WA
National Provider Identifier
1760473920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1820
- Practice address
- 22530 SE 64TH PL
Ste 140
Issaquah, WA 98027-5353 - Phone
- (425) 392-2020
- Fax
- (425) 392-1657
- NPI assigned
- Nov 4, 2005
- Last updated
- May 13, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1820 | WA | Primary |
Addresses
Primary practice location
22530 SE 64TH PL
Ste 140
Issaquah, WA 98027-5353
Mailing address
22530 SE 64TH PL
Ste 140
Issaquah, WA 98027-5353
Phone (425) 392-2020
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1820 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Global Eyecare | Optometrist | Past | Accepting new patients |
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.
-
- Optometrist
- Issaquah, WA
- NPI 1891935177
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242172800000",
"number": "1760473920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22530 SE 64TH PL",
"address_2": "STE 140",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275353",
"telephone_number": "425-392-2020",
"fax_number": "425-392-1657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22530 SE 64TH PL",
"address_2": "STE 140",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275353",
"telephone_number": "425-392-2020",
"fax_number": "425-392-1657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "MARK",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2009-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "1820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Issaquah, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.