Provider Demographics
NPI:1598743155
Name:LENANE, PATRICK A (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:LENANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 2ND AVE N
Mailing Address - Street 2:MEDICAL ARTS BLDG
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4119
Mailing Address - Country:US
Mailing Address - Phone:515-573-1145
Mailing Address - Fax:515-573-1028
Practice Address - Street 1:1428 2ND AVE N
Practice Address - Street 2:MEDICAL ARTS BLDG
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4119
Practice Address - Country:US
Practice Address - Phone:515-573-1145
Practice Address - Fax:515-573-1028
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5145540Medicaid
IA38024OtherBC/BS
IAIB1233002OtherMEDICARE ID - TYPE UNSPECIFIED
IA6153780001Medicare NSC
U63389Medicare UPIN
IAP00668077Medicare PIN