Provider Demographics
NPI:1144221581
Name:LENTZ, KATHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:MASON EYE INSTITUTE UNIVERSITY OF MISSOURI
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:MASON EYE INSTITUTE UNIVERSITY OF MISSOURI
Practice Address - Street 2:1 HOSPITAL DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5B94207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO752691501Medicaid
MO990001357Medicare ID - Type Unspecified
A11611Medicare UPIN
MO152360588Medicare PIN