Jensen, Clark Allen
Jensen, Clark Allen is an sole proprietor health care provider with primary practice located at 3101 Wyoming Blvd Sw , Casper WY 82604-4543. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jensen, Clark Allen can be contacted via phone (307) 265-7008.Contact Information
Primary practice address
3101 Wyoming Blvd Sw
Casper WY 82604-4543
Phone: (307) 265-7008
Fax: (307) 234-9405
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 166T | Wyoming |
Profile Details
| NPI number | 1952384125 |
|---|---|
| LBN Legal business name | Jensen, Clark Allen |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 22nd, 2005 |
| Last updated | Sep 14th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952384125 | NPPES |
| Wyoming | MEDICAID | 0803620001 |
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