Provider Demographics
NPI:1417126889
Name:RICHARD A. LANE MD PC
Entity Type:Organization
Organization Name:RICHARD A. LANE MD PC
Other - Org Name:NORTHERN EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:441 RIVER STREET
Mailing Address - Street 2:PO BOX 830
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156
Mailing Address - Country:US
Mailing Address - Phone:802-886-3937
Mailing Address - Fax:802-886-3167
Practice Address - Street 1:441 RIVER STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156
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:2008-02-29
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1282180001Medicare NSC