Provider Demographics
NPI:1295843134
Name:LORENZ, KENNETH D (OD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3700
Mailing Address - Fax:812-234-3565
Practice Address - Street 1:422 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4209
Practice Address - Country:US
Practice Address - Phone:812-242-3700
Practice Address - Fax:812-234-3565
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001615A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089617OtherANTHEM
02096OtherCIGNA
243410OtherHEALTHLINK
791580270OtherRAILROAD MCARE PALAMETTO
N280839OtherHARMONY HEALTH PLAN IND
0182864OtherUS DEPT OF LABOR
I017569C004OtherUNISYS CHAMPUS SECONDARY
IN100150840DOtherMOLINA HEALTHCARE MCAID
INP00834935OtherRAILROAD MEDICARE
IN100150840Medicaid
351904269136OtherCARESOURCE MEDICAID
4351954OtherAETNA
791580270OtherRAILROAD MCARE PALAMETTO
351904269136OtherCARESOURCE MEDICAID
IN100150840Medicaid