Provider Demographics
NPI:1609951474
Name:LANCASTER, JOHN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:402 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3593
Mailing Address - Country:US
Mailing Address - Phone:815-485-3431
Mailing Address - Fax:815-485-1986
Practice Address - Street 1:402 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3593
Practice Address - Country:US
Practice Address - Phone:815-485-3431
Practice Address - Fax:815-485-1986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410007262Medicare PIN
ILK48977Medicare PIN