Provider Demographics
NPI:1710996228
Name:LENHARDT, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:LENHARDT
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 1:501 N CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2744
Mailing Address - Country:US
Mailing Address - Phone:714-525-3350
Mailing Address - Fax:714-525-1310
Practice Address - Street 1:501 N CORNELL AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2744
Practice Address - Country:US
Practice Address - Phone:714-525-3350
Practice Address - Fax:714-525-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13041 TPG152W00000X
CAOPT13041TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA213323501OtherANTHEM BLUE CROSS OF CA
CAZZZ67199YOtherBLUE SHIELD OF CA
CACB246896Medicare PIN
CAZZZ67199YOtherBLUE SHIELD OF CA
CACB246897Medicare UPIN