Healthcare Provider Details

I. General information

NPI: 1710241583
Provider Name (Legal Business Name): JEFFREY JAMES LANT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 HIGHWAY K
O FALLON MO
63368-7865
US

IV. Provider business mailing address

9979 WINGHAVEN BLVD STE 210
O FALLON MO
63368-3628
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-5555
  • Fax: 636-978-5555
Mailing address:
  • Phone: 636-695-8555
  • Fax: 636-695-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2012019131
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: