Provider Demographics
NPI:1225216922
Name:JOEY L. LANE OPTOMETRIST, INC.
Entity Type:Organization
Organization Name:JOEY L. LANE OPTOMETRIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-485-4434
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:MCCONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-0697
Mailing Address - Country:US
Mailing Address - Phone:717-485-4434
Mailing Address - Fax:717-485-9407
Practice Address - Street 1:182 BUCHANAN TRAIL
Practice Address - Street 2:SUITE 185
Practice Address - City:MCCONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8261
Practice Address - Country:US
Practice Address - Phone:717-485-4434
Practice Address - Fax:717-485-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50075088OtherCAPITAL BLUE CROSS
PA1021216990001Medicaid
PA2020813OtherHIGHMARK BLUE SHIELD
PA6072760001Medicare NSC
PA123344Medicare PIN