Lanny F Duclos OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

113879-9934 Issued in UT

Legal business name

LANNY F DUCLOS OD PC

Practice address

88 E 700 N
Suite a
Tooele, UT 84074-1818

Phone

(435) 882-6452

Fax

(435) 882-3170

NPI assigned

Oct 20, 2006

Organization subpart

No

Name

Dr. Lanny F Duclos, ODNPI 1508827262

Title

Ceo

Phone

(435) 882-6452

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

• Lanny F Duclos, OD

  • Optometrist
  • Tooele, UT
  • NPI 1508827262
  Medicare reassignment Care Compare group NPD Authorized official
• Clifford Parker, OD

  • Optometrist
  • Ogden, UT
  • NPI 1841820792
  Medicare reassignment Care Compare group NPD

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

• Eye Health Professionals Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 30, 2008.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1972685402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 E 700 N",
            "address_2": "SUITE A",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840741818",
            "telephone_number": "435-882-6452",
            "fax_number": "435-882-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 E 700 N",
            "address_2": "SUITE A",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840741818",
            "telephone_number": "435-882-6452",
            "fax_number": "435-882-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANNY F DUCLOS OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "DUCLOS",
        "authorized_official_first_name": "LANNY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "14358826452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "UT",
            "license": "113879-9934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528118588003",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005327246",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT HEALTH",
            "identifier": "101001656101",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10898",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMETOWN HEALTH",
            "identifier": "17036",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80314",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "258200",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "W0620",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100510174",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TPRA06734",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Health Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mackenzi Kough
• Philip Krukow
• Randy Kwon, DMD
• Sarah Jane Lamoreaux, PA-C
• Subrina Langston
• Michele Marie Larson, FNP
• Spencer Larson, DO
• Soana Latu
• Kristi Lynn Lawrence, APRN FNP-C, PMHNP-BC
• Jennifer Clark Lawson, CRNA

• All providers in Tooele, UT
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.