Provider Demographics
NPI:1285619932
Name:LANE, JEFFERY RAY (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:RAY
Last Name:LANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5717 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4203
Mailing Address - Country:US
Mailing Address - Phone:512-327-7000
Mailing Address - Fax:512-314-1660
Practice Address - Street 1:5717 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-327-7000
Practice Address - Fax:512-314-1660
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5522TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10013124OtherAMERIGROUP
TX5199781OtherAETNA
VP12445OtherGE WELLNESS
TX101686702Medicaid
SC410045957Medicare PIN
SC410045606Medicare PIN
146572100OtherFIRST CARE
TX101686701Medicaid
TX0059051OtherBLUELINK
TX30532OtherCOLE VISION
TX80206QOtherBLUE CROSS BLUE SHIELD
U74471Medicare UPIN
TX81135EMedicare PIN
TX916443OtherBLOCK VISION
NY55343-007OtherDAVIS VISION
TX81136EMedicare PIN
OH115890OtherEYEMED