Provider Demographics
NPI:1336514496
Name:LENFESTY, OMAR (OD, ASC)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:LENFESTY
Suffix:
Gender:M
Credentials:OD, ASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1676
Mailing Address - Country:US
Mailing Address - Phone:610-544-4303
Mailing Address - Fax:610-544-5092
Practice Address - Street 1:1260 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3969
Practice Address - Country:US
Practice Address - Phone:610-544-4303
Practice Address - Fax:610-544-5092
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist