Organization
DAVID J. LANE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID JOSEPH LANE AU.D. (AUDIOLOGIST)
(618) 242-0672
Entity
Organization
Contact information
Practice address
4117 S WATER TOWER PL, SUITE C, MOUNT VERNON, IL 62864-6293
(618) 242-0672
(618) 242-0862
Mailing address
4117 S WATER TOWER PL, SUITE C, MOUNT VERNON, IL 62864-6293
(618) 242-0672
(618) 242-0862
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147000854
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
354668512001
—
IL
01
—
83222520
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/11/2006
Last updated
08/30/2010
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