Provider Demographics
NPI:1386757771
Name:LENIG, ALAN (OD)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:LENIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W FOX RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5201
Mailing Address - Country:US
Mailing Address - Phone:765-289-4727
Mailing Address - Fax:
Practice Address - Street 1:1608 WEST MCGALLIARD ROAD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2205
Practice Address - Country:US
Practice Address - Phone:765-289-4727
Practice Address - Fax:765-751-2207
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001625B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200047820AMedicaid
T81891Medicare UPIN
IN200047820AMedicaid