Provider Demographics
NPI:1932769528
Name:LORENZ, BRETT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
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 1:5316 S CHINOOK AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2588
Mailing Address - Country:US
Mailing Address - Phone:605-380-5404
Mailing Address - Fax:
Practice Address - Street 1:510 W EMPIRE MALL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-6509
Practice Address - Country:US
Practice Address - Phone:605-362-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist