Provider Demographics
NPI:1972997286
Name:LANNY S ODIN MD SC
Entity type:Organization
Organization Name:LANNY S ODIN MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ODIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:217-777-2020
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-0110
Mailing Address - Country:US
Mailing Address - Phone:217-777-2020
Mailing Address - Fax:217-777-2023
Practice Address - Street 1:500 N CHENEY ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1139
Practice Address - Country:US
Practice Address - Phone:217-777-2020
Practice Address - Fax:217-777-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty