Provider Demographics
NPI:1922135524
Name:LENTZ, ANITA AKIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:AKIN
Last Name:LENTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3244
Mailing Address - Country:US
Mailing Address - Phone:270-575-0977
Mailing Address - Fax:270-575-9793
Practice Address - Street 1:2302 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3244
Practice Address - Country:US
Practice Address - Phone:270-575-0977
Practice Address - Fax:270-575-9793
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1526DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0007581302OtherAETNA PIN
KY000000265430OtherANTHEM BCBS PIN
KY7700047900Medicaid
KY000000265430OtherANTHEM BCBS PIN
KYU85958Medicare UPIN