Provider Demographics
NPI:1073784930
Name:LENZ OPTICAL COMPANY INC
Entity Type:Organization
Organization Name:LENZ OPTICAL COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-0856
Mailing Address - Street 1:4012 DUPONT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4813
Mailing Address - Country:US
Mailing Address - Phone:502-897-0856
Mailing Address - Fax:502-897-6519
Practice Address - Street 1:4012 DUPONT CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4813
Practice Address - Country:US
Practice Address - Phone:502-897-0856
Practice Address - Fax:502-897-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY376332H00000X
KY120332S00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5280024000Medicaid
KY9084056200Medicaid
KY5290036200Medicaid
KY5290036200Medicaid