Provider Demographics
NPI:1659367498
Name:ENGLE-LANEVE, LYNN ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ELLEN
Last Name:ENGLE-LANEVE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:ELLEN
Other - Last Name:ENGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:172 MAJESTIC PT
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-9790
Mailing Address - Country:US
Mailing Address - Phone:304-965-6195
Mailing Address - Fax:
Practice Address - Street 1:806 GREENBRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1527
Practice Address - Country:US
Practice Address - Phone:304-342-5900
Practice Address - Fax:304-342-6257
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV985-OD152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3101004000Medicaid
WVU82088Medicare UPIN
WV3101004000Medicaid