Provider Demographics
NPI:1083758833
Name:LANIER, STEPHEN GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GREGORY
Last Name:LANIER
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 1:150 COLLEGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6212
Mailing Address - Country:US
Mailing Address - Phone:817-594-2311
Mailing Address - Fax:817-599-3461
Practice Address - Street 1:150 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6212
Practice Address - Country:US
Practice Address - Phone:817-594-2311
Practice Address - Fax:817-599-3461
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3961TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX917355OtherBLOCK VISION
TXT81933Medicare UPIN
TX00E46BMedicare PIN
TX0595510001Medicare NSC