Provider Demographics
NPI:1356628283
Name:LANE OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:LANE OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-508-4127
Mailing Address - Street 1:120 WYNDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6710
Mailing Address - Country:US
Mailing Address - Phone:910-508-4127
Mailing Address - Fax:
Practice Address - Street 1:1345 WESTERN BLVD STE 120B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7627
Practice Address - Country:US
Practice Address - Phone:910-376-8229
Practice Address - Fax:910-937-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty