Provider Demographics
NPI:1235124835
Name:LENSINK, DANIEL BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRUCE
Last Name:LENSINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2449
Mailing Address - Country:US
Mailing Address - Phone:530-229-7700
Mailing Address - Fax:530-229-3945
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:STE 101
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-229-7700
Practice Address - Fax:530-229-3945
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG599206207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G599260Medicaid
E19807Medicare UPIN
00G599260Medicare ID - Type Unspecified