Provider Demographics
NPI:1801871595
Name:LANE, MILTON JULIUS (BS, BSBA, MBA, OD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:JULIUS
Last Name:LANE
Suffix:
Gender:M
Credentials:BS, BSBA, MBA, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 N RODNEY PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4113
Mailing Address - Country:US
Mailing Address - Phone:501-225-4648
Mailing Address - Fax:501-225-8628
Practice Address - Street 1:10700 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4113
Practice Address - Country:US
Practice Address - Phone:501-225-4648
Practice Address - Fax:501-225-8628
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2219152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104558722Medicaid
AR48976Medicare PIN
ART20258Medicare UPIN