MEDICARE: KARINA DESAI LANNING O.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	152W00000X	Optometrist	0618002740	VA
2	152W00000X	Optometrist	6451	OH

General Provider Information

NPI Number	:	1720431760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA DESAI LANNING O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207170
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7156
Country	:	US
Telephone Number	:	636-527-0766
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	105 MOREY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1647
Country	:	US
Telephone Number	:	937-642-2002
Fax Number	:	937-642-3620

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

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	08/27/2021

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