Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0983 | NC |
NPI | 1003818972 |
---|---|
Provider Name | Dr. Kenneth John Lentz JR. |
First Address | Spruce Pine, NC 28777-0665 |
Second Address | Spruce Pine, NC 28777-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22-09157 | US HEALTH CARE (01) | NC |
8909545 | (05) | NC |
T64634 | (02) |