Provider Demographics
NPI:1831308386
Name:LANE EYE CARE CENTER, P.A.
Entity type:Organization
Organization Name:LANE EYE CARE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-982-8833
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0099
Mailing Address - Country:US
Mailing Address - Phone:501-982-8833
Mailing Address - Fax:501-985-6806
Practice Address - Street 1:625 N 1ST ST STE A
Practice Address - Street 2:STE A
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4138
Practice Address - Country:US
Practice Address - Phone:501-982-8833
Practice Address - Fax:501-985-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110945722Medicaid
0454830001Medicare NSC
AR48976Medicare PIN
T20258Medicare UPIN