Provider Demographics
NPI:1386378339
Name:J MARTIN LANE EYECARE CENTER
Entity type:Organization
Organization Name:J MARTIN LANE EYECARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MARTIN LANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-980-1194
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-0683
Mailing Address - Country:US
Mailing Address - Phone:270-365-6627
Mailing Address - Fax:270-365-7700
Practice Address - Street 1:101 E SHEPARDSON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-1633
Practice Address - Country:US
Practice Address - Phone:270-365-6627
Practice Address - Fax:270-365-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty