Provider Demographics
NPI:1417084385
Name:RICHARD A. LANE MD PC
Entity Type:Organization
Organization Name:RICHARD A. LANE MD PC
Other - Org Name:LANE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-886-3937
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0830
Mailing Address - Country:US
Mailing Address - Phone:802-886-3937
Mailing Address - Fax:802-886-3167
Practice Address - Street 1:441 RIVER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2222
Practice Address - Country:US
Practice Address - Phone:802-886-3937
Practice Address - Fax:802-886-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH302102 40Medicaid
180035977OtherRAILROAD MEDICARE
1282180001OtherMEDICARE NSC
180045876OtherRAILROAD MEDICARE
VTOVN1908Medicaid
180045876OtherRAILROAD MEDICARE
VTVN1908Medicare PIN