Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | KY0376 | KY |
Y | 156FX1700X | Ocularist | NA | KY |
N | 156FX1800X | Optician | KY0376 | KY |
NPI | 1134286123 |
---|---|
Provider Name | William Bruce Lenz |
First Address | Louisville, KY 40207-4813 |
Second Address | Louisville, KY 40207-4813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5280024000 | (05) | KY |
5290036200 | (05) | KY |
9084056200 | (05) | KY |