MEDICARE: DR. JENNINE C LUTZ O.D

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	27OA 00582000	NJ

General Provider Information

NPI Number	:	1568411270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNINE C LUTZ O.D

Provider Business Mailing Address
First Line	:	110 GEORGE ST
Second Line	:
City	:	ROBBINSVILLE
State	:	NJ
Zip	:	08691-4176
Country	:	US
Telephone Number	:	609-259-1039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 PARKWAY AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-3018
Country	:	US
Telephone Number	:	609-882-8833
Fax Number	:

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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