Provider Demographics
NPI:1235262163
Name:MARK LANIER OD PC
Entity Type:Organization
Organization Name:MARK LANIER OD PC
Other - Org Name:NACOGDOCHES EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-564-7661
Mailing Address - Street 1:PO BOX 632600
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2600
Mailing Address - Country:US
Mailing Address - Phone:936-564-7661
Mailing Address - Fax:936-564-6622
Practice Address - Street 1:3208 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2633
Practice Address - Country:US
Practice Address - Phone:936-564-7661
Practice Address - Fax:936-564-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03357TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0228470001OtherMEDICARE DME JURISDICTION C
TX164994901Medicaid
TX00000099FAOtherBCBS
TXDA0550OtherRAILROAD MEDICARE
TXDA0550OtherRAILROAD MEDICARE
TX164994901Medicaid