Healthcare Provider Details

I. General information

NPI: 1316155815
Provider Name (Legal Business Name): LANE EYE CARE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E SECOND ST
MCCRORY AR
72101
US

IV. Provider business mailing address

PO BOX 630
MCCRORY AR
72101-0630
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-5706
  • Fax: 870-731-2168
Mailing address:
  • Phone: 870-731-5706
  • Fax: 870-731-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberD22219
License Number StateAR

VIII. Authorized Official

Name: DR. MILTON J LANE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 870-731-5706