Individual provider Active NPI

Jerry Allan Lantz, O.D.

  • Optometrist
  • Parkersburg, WV
National Provider Identifier
1407842529
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
779-D Issued in WV
Practice address
2014 Dudley Ave
Parkersburg, WV 26101-3405
Phone
(304) 422-1841
Fax
(304) 865-0592
NPI assigned
Sep 23, 2005
Last updated
Feb 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 779-D WV Primary

Addresses

Primary practice location

2014 Dudley Ave
Parkersburg, WV 26101-3405

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970

Other identifiers 1

IdentifierTypeStateIssuer
0150852000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120725000744 WV Practitioner - Optometry 7719090109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2014 Dudley Ave
Parkersburg, WV 26101-3405
Phone (304) 422-1841

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
779-DWVMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of West Virginia, PLLC Optometrist Current Accepting new patients
Myeyedr Optometry of West Virginia, PLLC Optometrist CurrentSince Feb 13, 2019 Accepting new patients
Myeyedr Optometry of West Virginia, PLLC Optometrist CurrentSince Feb 13, 2019 Accepting new patients
Myeyedr Optometry of West Virginia, PLLC Optometrist Past Accepting new patients

Locations

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

838 Somerset Blvd
Charles Town, WV 25414
Phone (304) 725-4828

2014 Dudley Ave
Parkersburg, WV 26101
Phone (304) 422-1841

227 Main St
Spencer, WV 25276
Phone (304) 927-5910

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1407842529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 DUDLEY AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261013405",
            "telephone_number": "304-422-1841",
            "fax_number": "304-865-0592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANTZ",
        "first_name": "JERRY",
        "middle_name": "ALLAN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "779-D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150852000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parkersburg, WV

Sources for this page

Verify at the official NPI Registry.