Lantz, Mark Wayne

Lantz, Mark Wayne is an individual health care provider with primary practice located at 2555 Phillips Field Rd , Fairbanks AK 99709-3933. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Lantz, Mark Wayne can be contacted via phone (907) 328-2980.

Contact Information

Primary practice address
2555 Phillips Field Rd Fairbanks AK 99709-3933
Phone: (907) 328-2980
Fax: (907) 456-2914
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1934DT Kentucky
Eye and Vision Services Providers / Optometrist 152W00000X 4901004481 Michigan
Eye and Vision Services Providers / Optometrist 152W00000X 171851 Alaska

Profile Details

NPI number 1295909398
LBN Legal business name Lantz, Mark Wayne
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2008
Last updated Apr 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295909398 NPPES
Michigan Other 900A210610 BCBSM

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