Active NPI
Kenneth D Lorenz, O.D.
- Optometrist
- Terre Haute, IN
National Provider Identifier
1295843134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18001615A
- Practice address
- 422 Poplar St
Terre Haute, IN 47807-4209 - Phone
- (812) 242-3700
- Fax
- (812) 234-3565
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001615A | IN | Primary |
Addresses
Primary practice location
422 Poplar St
Terre Haute, IN 47807-4209
Mailing address
221 S 6TH St
Terre Haute, IN 47807-4214
Phone (812) 242-3700
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000089617 | Other | ANTHEM | |
| 02096 | Other | CIGNA | |
| 243410 | Other | HEALTHLINK | |
| 791580270 | Other | RAILROAD MCARE PALAMETTO | |
| N280839 | Other | HARMONY HEALTH PLAN IND | |
| 0182864 | Other | US DEPT OF LABOR | |
| I017569C004 | Other | UNISYS CHAMPUS SECONDARY | |
| 100150840D | Other | IN | MOLINA HEALTHCARE MCAID |
| P00834935 | Other | IN | RAILROAD MEDICARE |
| 100150840 | Medicaid | IN | |
| 351904269136 | Other | CARESOURCE MEDICAID | |
| 4351954 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001615A | IN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282089600000",
"number": "1295843134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 S 6TH ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478074214",
"telephone_number": "812-242-3700",
"fax_number": "812-234-3565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "422 POPLAR ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478074209",
"telephone_number": "812-242-3700",
"fax_number": "812-234-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LORENZ",
"first_name": "KENNETH",
"middle_name": "D",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2010-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18001615A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000089617",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "02096",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "243410",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MCARE PALAMETTO",
"identifier": "791580270",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARMONY HEALTH PLAN IND",
"identifier": "N280839",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "0182864",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISYS CHAMPUS SECONDARY",
"identifier": "I017569C004",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA HEALTHCARE MCAID",
"identifier": "100150840D",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00834935",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100150840",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE MEDICAID",
"identifier": "351904269136",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4351954",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.