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General NPI Number Information
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NPI Number | 1225269848
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Entity Type | Organization
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Legal Business Name | LENHARD PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 2292 MAIN ST
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City | GREEN BAY
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State | WI
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Zip | 54311-5307
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Country | US
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Telephone | 920-465-7990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22576
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City | GREEN BAY
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State | WI
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Zip | 54305-2576
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Country | US
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Telephone | 920-469-7970
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TODD M LENHARD
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Credential | OPTOMETRIST
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Telephone | 920-469-7970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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