MEDICARE: DR. MARY BETH LANSING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	36103	CO
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	36103	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C51901	OTHER	CO	MEDICARE ID
3	C811156	OTHER	CO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528059573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BETH LANSING M.D.

Provider Business Mailing Address
First Line	:	90 HEALTH PARK DR
Second Line	:	SUITE 100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9757
Country	:	US
Telephone Number	:	303-666-1800
Fax Number	:	303-666-8830

Provider Business Practice Location Address
First Line	:	90 HEALTH PARK DR
Second Line	:	SUITE 100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9757
Country	:	US
Telephone Number	:	303-666-1800
Fax Number	:	303-666-8830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	04/29/2021

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