David J. Lane, LTD.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

147000854 Issued in IL

Legal business name

DAVID J. LANE, LTD.

Practice address

4117 S Water Tower PL
Suite C
Mount Vernon, IL 62864-6293

Phone

(618) 242-0672

Fax

(618) 242-0862

NPI assigned

Dec 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Joseph Lane, AU.D.NPI 1164472155

Title

Audiologist

Phone

(618) 242-0672

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David J Lane, AU.D., CCC-A

  • Audiologist
  • Mount Vernon, IL
  • NPI 1164472155
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1821158833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4117 S WATER TOWER PL",
            "address_2": "SUITE C",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-242-0672",
            "fax_number": "618-242-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 S WATER TOWER PL",
            "address_2": "SUITE C",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-242-0672",
            "fax_number": "618-242-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID J. LANE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "AUDIOLOGIST",
        "authorized_official_telephone_number": "618-242-0672",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AU.D."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Audiologist",
            "state": "IL",
            "license": "147000854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "354668512001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "83222520",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Merenda L Dale, LCSW
• Shirley Dallmier, P.A.
• Olivia Nanette Dalmasso, LPN
• Ashley Daniels, FNP
• Chirag Dave, M.D.
• Alicia Davis
• Carl Robert Davis, CRNA
• Dennon W Davis, M.D.
• Duane Allen Davis, D.M.D.
• Heather Dawn Davis, APRN,FNP-C

• Audiologist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Audiologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.