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General NPI Number Information
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NPI Number | 1982063335
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Entity Type | Organization
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Legal Business Name | JENNIFER C LANE OD PLLC
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Dates
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Enumeration Date | 02/14/2016
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Last Update Date | 02/14/2016
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Provider Practice Location Address
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Address Line | 12130 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-6908
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Country | US
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Telephone | 757-249-1324
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1056
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City | SUFFOLK
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State | VA
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Zip | 23439-1056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. JENNIFER LANE
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Credential | O.D.
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Telephone | 757-759-1416
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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 | 0618001867
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License Number State | VA
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