Provider Demographics
NPI:1841263217
Name:CHAMPION, LENKA S (MD)
Entity type:Individual
Prefix:DR
First Name:LENKA
Middle Name:S
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LENKA
Other - Middle Name:S
Other - Last Name:CHAMPION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 1503
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6298
Mailing Address - Country:US
Mailing Address - Phone:904-903-4068
Mailing Address - Fax:904-900-5347
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1503
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:904-903-4068
Practice Address - Fax:904-900-5347
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91805207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI46140Medicare UPIN
FLU6310ZMedicare PIN