Provider Demographics
NPI:1619918216
Name:LORENZ, JASON ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ARTHUR
Last Name:LORENZ
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 1:500 N HWY 281
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1821
Mailing Address - Country:US
Mailing Address - Phone:605-225-7677
Mailing Address - Fax:605-225-4170
Practice Address - Street 1:500 N HWY 281
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1821
Practice Address - Country:US
Practice Address - Phone:605-225-7677
Practice Address - Fax:605-225-4170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201960Medicaid
SD9201960Medicaid
SD76555Medicare ID - Type Unspecified