Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3110 | MN |
N | 152WS0006X | Sports Vision | 3110 | MN |
NPI | 1093997843 |
---|---|
Provider Name | Thomas J Lenz |
First Address | Willmar, MN 56201-4946 |
Second Address | Willmar, MN 56201-4946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2007 |
Last Update Date | 16/01/2008 |