Provider Demographics
NPI:1891762282
Name:ROBESON, LANE C (OD)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:C
Last Name:ROBESON
Suffix:
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 1:1400 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6044
Mailing Address - Country:US
Mailing Address - Phone:507-454-4092
Mailing Address - Fax:507-454-5384
Practice Address - Street 1:1400 HOMER RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6044
Practice Address - Country:US
Practice Address - Phone:507-454-4092
Practice Address - Fax:507-454-5384
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN737823800Medicaid
MN70739ROOtherBCBS
MNHP38929OtherHEALTH PARTNERS
MN70739ROOtherBCBS
MNT39413Medicare UPIN