Provider Demographics
NPI:1750449211
Name:LANNING, DOUGLAS HOWARD (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HOWARD
Last Name:LANNING
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 1:2437 BUHNE ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3206
Mailing Address - Country:US
Mailing Address - Phone:707-443-4581
Mailing Address - Fax:
Practice Address - Street 1:2437 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3206
Practice Address - Country:US
Practice Address - Phone:707-443-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12163T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0121630Medicaid
CASD0121630Medicaid
CASD0121630Medicare ID - Type Unspecified