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NPI Code Detail

MEDICARE: MARK LANIER OD PC

MEDICARE: MARK LANIER OD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist03357TGTX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10228470001OTHERTXMEDICARE DME JURISDICTION C
4DA0550OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
300000099FAOTHERTXBCBS

General Provider Information

NPI Number : 1235262163
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK LANIER OD PC
Provider Business Mailing Address
First Line : PO BOX 632600
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2600
Country : US
Telephone Number : 936-564-7661
Fax Number : 936-564-6622
Provider Business Practice Location Address
First Line : 3208 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2633
Country : US
Telephone Number : 936-564-7661
Fax Number : 936-564-6622
Authorized Official
Title or Position : OWNER
Name : DR. MARK R LANIER
Credential : OD
Telephone Number : 936-564-7661
Provider Enumeration Date : 03/13/2007
Last Update Date : 12/03/2008

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