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General NPI Number Information
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NPI Number | 1316155815
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Entity Type | Organization
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Legal Business Name | LANE EYE CARE CENTER, P.A.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 119 E SECOND ST
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City | MCCRORY
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State | AR
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Zip | 72101
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Country | US
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Telephone | 870-731-5706
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Fax | 870-731-2168
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Provider Business Mailing Address
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Address Line | PO BOX 630
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City | MCCRORY
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State | AR
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Zip | 72101-0630
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Country | US
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Telephone | 870-731-5706
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Fax | 870-731-5706
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MILTON J LANE
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Credential | O.D.
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Telephone | 870-731-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | D22219
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License Number State | AR
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