Provider Demographics
NPI:1619411519
Name:DANIEL B LENSINK MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DANIEL B LENSINK MEDICAL CORPORATION
Other - Org Name:OCULOFACIAL PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LENSINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-229-7700
Mailing Address - Street 1:2770 EUREKA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0252
Mailing Address - Country:US
Mailing Address - Phone:530-229-7700
Mailing Address - Fax:530-229-3945
Practice Address - Street 1:2770 EUREKA WAY
Practice Address - Street 2:STE 300
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0252
Practice Address - Country:US
Practice Address - Phone:530-229-7700
Practice Address - Fax:530-229-3945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL B LENSINK MD MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG599260261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE19807Medicare UPIN
CAZZZ02371ZMedicare PIN