Individual
JERRY ALLAN LANTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2014 DUDLEY AVE, PARKERSBURG, WV 26101-3405
(304) 422-1841
(304) 865-0592
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
779-D
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150852000
—
WV
Enumeration date
09/23/2005
Last updated
02/14/2022
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