MEDICARE: LANE EYE CARE CENTER, P.A.

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
1	152W00000X	Optometrist	2219	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1831308386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANE EYE CARE CENTER, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72078-0099
Country	:	US
Telephone Number	:	501-982-8833
Fax Number	:	501-985-6806

Provider Business Practice Location Address
First Line	:	625 N 1ST ST STE A
Second Line	:	STE A
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4138
Country	:	US
Telephone Number	:	501-982-8833
Fax Number	:	501-985-6806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MILTON J LANE
Credential	:	O.D.
Telephone Number	:	501-982-8833

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	03/05/2008

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Directions to “LANE EYE CARE CENTER, P.A. ” Practice Location

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