Provider Demographics
NPI:1447464524
Name:KENT CHARLES JENSEN OD
Entity type:Organization
Organization Name:KENT CHARLES JENSEN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-764-7575
Mailing Address - Street 1:15316 HUEBNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-0987
Mailing Address - Country:US
Mailing Address - Phone:210-764-7575
Mailing Address - Fax:210-764-7576
Practice Address - Street 1:15316 HUEBNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0987
Practice Address - Country:US
Practice Address - Phone:210-764-7575
Practice Address - Fax:210-764-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3951TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841360633OtherINDIVIDUAL NPI