Provider Demographics
NPI:1578620175
Name:LANCASTER, COLEMAN HARRISON JR (OD)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:HARRISON
Last Name:LANCASTER
Suffix:JR
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 1:129 S. BICKETT BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2605
Mailing Address - Country:US
Mailing Address - Phone:919-496-2328
Mailing Address - Fax:
Practice Address - Street 1:129 SHANNON VLG
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2605
Practice Address - Country:US
Practice Address - Phone:919-496-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0262COtherBCBS OF NC
NC89012N3Medicaid
NC8802036Medicaid
NC5337300001Medicare NSC
U28216Medicare UPIN
NC89012N3Medicaid