Provider Demographics
NPI:1962584946
Name:DOUGLAS H. LANNING, O.D.
Entity type:Organization
Organization Name:DOUGLAS H. LANNING, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-443-4581
Mailing Address - Street 1:2437 BUHNE ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3206
Mailing Address - Country:US
Mailing Address - Phone:707-443-4581
Mailing Address - Fax:
Practice Address - Street 1:2437 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3206
Practice Address - Country:US
Practice Address - Phone:707-443-4581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12163T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0121630Medicaid
CAGSD005070Medicaid
CAEH755AMedicaid
CASD0065450Medicaid
CAEH7712Medicaid
CAEH7712Medicaid
CAZZZ01589ZMedicare PIN
CASD0065450Medicaid
CA5481990001Medicare NSC