Provider Demographics
NPI:1033112420
Name:LANE, LYDIA F (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:F
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:L
Other - Last Name:DWORKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 EXECUTIVE CT
Mailing Address - Street 2:STE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:9800 LILE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6229
Practice Address - Country:US
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-224-8114
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4078207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152971001Medicaid
AR152971001Medicaid
H87061Medicare UPIN