Provider Demographics
NPI:1760612527
Name:LANE, ASHLEY BROOKE (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BROOKE
Last Name:LANE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 PALOMAR CENTRE DR STE 170
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1121
Mailing Address - Country:US
Mailing Address - Phone:859-271-2020
Mailing Address - Fax:859-271-2027
Practice Address - Street 1:3735 PALOMAR CENTRE DR STE 170
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1121
Practice Address - Country:US
Practice Address - Phone:859-271-2020
Practice Address - Fax:859-271-2027
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1766DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100085310Medicaid