Provider Demographics
NPI:1770534919
Name:STEAHLY, LANCE P (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:P
Last Name:STEAHLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 DUNFRIES CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3864
Mailing Address - Country:US
Mailing Address - Phone:719-494-3512
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIRCLE
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-494-3512
Practice Address - Fax:719-494-3512
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072708207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072708Medicaid
ILD16039Medicare UPIN
IL036072708Medicaid
ILL98818Medicare PIN