Provider Demographics
NPI:1225079155
Name:LANNIN, W CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:CRAIG
Last Name:LANNIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1823
Mailing Address - Country:US
Mailing Address - Phone:530-243-4782
Mailing Address - Fax:530-243-7013
Practice Address - Street 1:1950 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1823
Practice Address - Country:US
Practice Address - Phone:530-243-4782
Practice Address - Fax:530-243-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX58910Medicaid
CA00AX58910Medicaid
CA020A58910Medicare PIN