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General NPI Number Information
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NPI Number | 1326442559
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Entity Type | Individual
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Provider Name | BROOKE MILLISON LANE DAVID OD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 6101 LEE HWY
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2932
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Country | US
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Telephone | 423-954-1746
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Fax |
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Provider Business Mailing Address
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Address Line | 15 IRIS LN
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City | CROSSVILLE
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State | TN
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Zip | 38555-7528
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Country | US
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Telephone | 931-456-2728
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Fax | 931-456-5446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1847
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD3477
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License Number State | TN
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