Provider Demographics
NPI:1215040944
Name:LENZ, JAN CLENNEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:CLENNEY
Last Name:LENZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 S. MONTGOMERY AVE
Mailing Address - Street 2:TENNESSEE RIVER EYE CLINIC
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660
Mailing Address - Country:US
Mailing Address - Phone:256-381-2020
Mailing Address - Fax:256-381-7754
Practice Address - Street 1:1110 S. MONTGOMERY AVE
Practice Address - Street 2:TENNESSEE RIVER EYE CLINIC
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660
Practice Address - Country:US
Practice Address - Phone:256-320-2020
Practice Address - Fax:256-381-7754
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS704TA052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL207563Medicaid
AL58378Medicare ID - Type Unspecified