1598743155 NPI number — DR. PATRICK A LENANE O.D.

Table of content: DR. PATRICK A LENANE O.D. (NPI 1598743155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598743155 NPI number — DR. PATRICK A LENANE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENANE
Provider First Name:
PATRICK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598743155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1428 2ND AVE N
Provider Second Line Business Mailing Address:
MEDICAL ARTS BLDG
Provider Business Mailing Address City Name:
FORT DODGE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50501-4119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-573-1145
Provider Business Mailing Address Fax Number:
515-573-1028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1428 2ND AVE N
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-573-1145
Provider Business Practice Location Address Fax Number:
515-573-1028
Provider Enumeration Date:
01/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2074 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5145540 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38024 . This is a "BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IB1233002 . This is a "MEDICARE ID - TYPE UNSPECIFIED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".