Provider Demographics
NPI:1902861719
Name:LANTMAN EYE CARE
Entity Type:Organization
Organization Name:LANTMAN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LANTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-894-5025
Mailing Address - Street 1:4926 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1827
Mailing Address - Country:US
Mailing Address - Phone:423-894-5025
Mailing Address - Fax:423-894-8087
Practice Address - Street 1:4926 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1827
Practice Address - Country:US
Practice Address - Phone:423-894-5025
Practice Address - Fax:423-894-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5135800001Medicare NSC
TNDB9359Medicare PIN
TNU63577Medicare UPIN