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Individual

RENEE KATHLEEN LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
12862 STATE ROUTE 21, DE SOTO, MO 63020-4742
(636) 586-9745
(636) 586-0901
Mailing address
5397 OAK GROVE CHURCH RD, PO BOX 37, LONEDELL, MO 63060-1025
(636) 744-5467

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2012037795
MO

Other

Enumeration date
11/02/2012
Last updated
01/10/2014
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