Individual
JENNIFER JO MARTIN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1111A FORT CAMPBELL BLVD, CLARKSVILLE, TN 37042-6426
(931) 645-0346
(931) 645-0348
Mailing address
101 E SHEPARDSON ST, PRINCETON, KY 42445-1633
(270) 365-6627
(931) 645-0348
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1631DT
KY
152W00000X
Optometrist
3098-035
WI
152W00000X
Optometrist
Primary
3423
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77001501
—
KY
05
—
Q032337
—
TN
Enumeration date
12/04/2007
Last updated
01/08/2020
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