Provider Demographics
NPI:1477531796
Name:LANKFORD, BRIAN JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAY
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-4014
Mailing Address - Country:US
Mailing Address - Phone:252-823-3202
Mailing Address - Fax:252-641-5087
Practice Address - Street 1:807 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4014
Practice Address - Country:US
Practice Address - Phone:252-823-3202
Practice Address - Fax:252-641-5087
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909278Medicaid
NC09278OtherBLUE CROSS/BLUE SHIELD
NC8909278Medicaid
NC09278OtherBLUE CROSS/BLUE SHIELD
NC1005560001Medicare NSC