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General NPI Number Information
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NPI Number | 1972997286
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Entity Type | Organization
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Legal Business Name | LANNY S ODIN MD SC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 500 N CHENEY ST
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City | TAYLORVILLE
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State | IL
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Zip | 62568-1139
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Country | US
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Telephone | 217-777-2020
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Fax | 217-777-2023
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Provider Business Mailing Address
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Address Line | PO BOX 110
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City | TAYLORVILLE
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State | IL
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Zip | 62568-0110
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Country | US
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Telephone | 217-777-2020
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Fax | 217-777-2023
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Authorized Official
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Title or Position | PRESIDENT
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Name | LANNY SCOTT ODIN
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Credential | M. D.
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Telephone | 217-777-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | IL
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