Provider Demographics
NPI:1780133058
Name:LORENZ, KATHRINE OSBORN (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:OSBORN
Last Name:LORENZ
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 1:7500 CENTURION PKWY
Mailing Address - Street 2:SUITE 100 D-GMA
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0517
Mailing Address - Country:US
Mailing Address - Phone:904-443-1032
Mailing Address - Fax:
Practice Address - Street 1:7500 CENTURION PKWY
Practice Address - Street 2:SUITE 100 D-GMA
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0517
Practice Address - Country:US
Practice Address - Phone:904-443-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3260152W00000X
OH4670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist