Healthcare Provider Details

I. General information

NPI: 1053307652
Provider Name (Legal Business Name): RICHARD ALEXANDER LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 RIVER ST
SPRINGFIELD VT
05156-2222
US

IV. Provider business mailing address

441 RIVER ST PO BOX 830
SPRINGFIELD VT
05156-2222
US

V. Phone/Fax

Practice location:
  • Phone: 802-886-3937
  • Fax: 802-886-3167
Mailing address:
  • Phone: 802-886-3937
  • Fax: 802-886-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0420007541
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: