Provider Demographics
NPI:1184638413
Name:LAWHORN, ZANE RENE (OD)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:RENE
Last Name:LAWHORN
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 1:310 LOCUST ST
Mailing Address - Street 2:#6
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740
Mailing Address - Country:US
Mailing Address - Phone:304-487-2020
Mailing Address - Fax:304-431-2020
Practice Address - Street 1:310 LOCUST ST.
Practice Address - Street 2:#6
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-487-2020
Practice Address - Fax:304-431-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV807-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150960000Medicaid
WV1344807OtherFUNDS PROVIDER NUMBER
WV410030194OtherRAILROAD MEDICARE NUMBER
WV0150960000Medicaid
WV1344807OtherFUNDS PROVIDER NUMBER