Provider Demographics
NPI:1235252354
Name:LENZEN, MARC WESLEY (O D)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:WESLEY
Last Name:LENZEN
Suffix:
Gender:M
Credentials:O D
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Mailing Address - Street 1:27270 ALICIA PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3413
Mailing Address - Country:US
Mailing Address - Phone:949-448-7464
Mailing Address - Fax:949-448-7469
Practice Address - Street 1:27270 ALICIA PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3413
Practice Address - Country:US
Practice Address - Phone:949-448-7464
Practice Address - Fax:949-448-7469
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist