Provider Demographics
NPI:1538100607
Name:LANIER, JAMES CURETON IV (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CURETON
Last Name:LANIER
Suffix:IV
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 1:806 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3337
Mailing Address - Country:US
Mailing Address - Phone:904-356-7101
Mailing Address - Fax:904-356-7947
Practice Address - Street 1:7077 NORMANDY BLVD STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6294
Practice Address - Country:US
Practice Address - Phone:904-781-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20125AOtherBCBS
FL20125OtherBCBS
FL6183330001Medicare NSC
FL410040103Medicare PIN
FL20125XMedicare PIN
FL6183330002Medicare NSC
FLP00737877Medicare PIN