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General NPI Number Information
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NPI Number | 1174972111
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Entity Type | Individual
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Provider Name | LEAH LENTZ HERRON O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 6 S 14TH ST
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City | FERNANDINA
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-261-5741
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Fax | 904-261-7383
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Provider Business Mailing Address
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Address Line | 6 S 14TH ST
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City | FERNANDINA
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State | FL
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Zip | 32034-3212
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Country | US
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Telephone | 904-261-5741
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Fax | 904-261-7383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002938
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5332
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License Number State | FL
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