Provider Demographics
NPI:1992196521
Name:LENHARDT OPTOMETRIC GROUP INC.
Entity Type:Organization
Organization Name:LENHARDT OPTOMETRIC GROUP INC.
Other - Org Name:LENHARDT OPTOMETRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-525-3350
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13041 TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA213323501OtherANTHEM BLUE CROSS OF CA
CAZZZ67199YOtherBLUE SHIELD OF CA
CAZZZ67199YOtherBLUE SHIELD OF CA
CACB246896Medicare UPIN
CACB246897Medicare PIN