Organization
JILL M LANE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL MARIE LANE O.D. (PRESIDENT/PHYSICIAN)
(208) 983-3732
Entity
Organization
Contact information
Practice address
405 E MAIN ST, GRANGEVILLE, ID 83530-2239
(208) 983-3732
(208) 983-3738
Mailing address
405 E MAIN ST, GRANGEVILLE, ID 83530-2239
(208) 983-3732
(208) 983-3738
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100095
ID
Other
Enumeration date
04/01/2008
Last updated
01/12/2017
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