Provider Demographics
NPI:1699401182
Name:LANCASTER, KORTNY CLAYTON (OD)
Entity type:Individual
Prefix:
First Name:KORTNY
Middle Name:CLAYTON
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3032
Mailing Address - Country:US
Mailing Address - Phone:307-332-2020
Mailing Address - Fax:
Practice Address - Street 1:556 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3032
Practice Address - Country:US
Practice Address - Phone:307-332-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY452T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist