Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | E4078 | AR |
NPI | 1033112420 |
---|---|
Provider Name | Lydia F Lane |
First Address | Little Rock, AR 72205-4536 |
Second Address | Little Rock, AR 72205-6229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152971001 | (05) | AR |
H87061 | (02) |