Active NPI
Michael Lane, OD
- Optometrist
- Chesterfield, MO
National Provider Identifier
1144338393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TO2780
- Practice address
- 92 Chesterfield Mall
Chesterfield, MO 63017-4808 - Phone
- (636) 530-0202
- Fax
- (636) 537-0905
- NPI assigned
- Aug 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TO2780 | MO | Primary |
Addresses
Primary practice location
92 Chesterfield Mall
Chesterfield, MO 63017-4808
Mailing address
99 S Clay Ave
Ferguson, MO 63135-2445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO2780 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chabot Community Eye Care PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144338393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 S CLAY AVE",
"city": "FERGUSON",
"state": "MO",
"postal_code": "631352445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 CHESTERFIELD MALL",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630174808",
"telephone_number": "636-530-0202",
"fax_number": "636-537-0905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "MICHAEL",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "TO2780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesterfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.