Provider Demographics
NPI:1669490702
Name:LEMON, LANCE CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:CAMERON
Last Name:LEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8547
Mailing Address - Country:US
Mailing Address - Phone:517-393-2020
Mailing Address - Fax:517-393-5050
Practice Address - Street 1:3390 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8547
Practice Address - Country:US
Practice Address - Phone:517-393-2020
Practice Address - Fax:517-393-5050
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4275403Medicaid
MI4275403Medicaid
MI0N96540Medicare PIN