MEDICARE: MARK MATTHEW LEHMANN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10225T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619936481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MATTHEW LEHMANN OD

Provider Business Mailing Address
First Line	:	1394 FRIANT DR
Second Line	:
City	:	S LAKE TAHOE
State	:	CA
Zip	:	96150-8061
Country	:	US
Telephone Number	:	530-541-2030
Fax Number	:	536-541-3947

Provider Business Practice Location Address
First Line	:	2074 LAKE TAHOE BLVD STE 2
Second Line	:
City	:	S LAKE TAHOE
State	:	CA
Zip	:	96150-6408
Country	:	US
Telephone Number	:	530-541-2030
Fax Number	:	536-541-3947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	03/07/2023

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