Provider Demographics
NPI:1790077980
Name:LENTZ ENTERPRISES, LLC
Entity Type:Organization
Organization Name:LENTZ ENTERPRISES, LLC
Other - Org Name:LENTZ EYE CARE & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-634-2020
Mailing Address - Street 1:120 W 6TH ST
Mailing Address - Street 2:SUITE 185
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2155
Mailing Address - Country:US
Mailing Address - Phone:316-283-7453
Mailing Address - Fax:316-283-7669
Practice Address - Street 1:120 W 6TH ST
Practice Address - Street 2:SUITE 185
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2155
Practice Address - Country:US
Practice Address - Phone:316-283-7453
Practice Address - Fax:316-283-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS515481Medicare PIN
KS0853440001Medicare NSC