Provider Demographics
NPI:1003940453
Name:MCNAUGHTON, LANCE (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:MCNAUGHTON
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 POTOMAC AVE SE APT 916
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3746
Mailing Address - Country:US
Mailing Address - Phone:714-272-7480
Mailing Address - Fax:
Practice Address - Street 1:1811 G ST
Practice Address - Street 2:
Practice Address - City:JB ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762-5677
Practice Address - Country:US
Practice Address - Phone:301-735-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13892TPA152WC0802X
MDTA2019152WC0802X
DCOP2000527152WC0802X
VA0618001819152WC0802X
CA13892T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACX089ZOtherMEDICARE PTAN