Provider Demographics
NPI:1649309808
Name:LANE, PATRICK FRANKLIN (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:FRANKLIN
Last Name:LANE
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 1:1507 US HIGHWAY 25 E
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1862
Mailing Address - Country:US
Mailing Address - Phone:606-248-3474
Mailing Address - Fax:606-248-3937
Practice Address - Street 1:1507 US HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1862
Practice Address - Country:US
Practice Address - Phone:606-248-3474
Practice Address - Fax:606-248-3937
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77005502Medicaid
KY77005502Medicaid