Martin Lane, Jennifer Jo

Martin Lane, Jennifer Jo is an individual health care provider with primary practice located at 1111A Fort Campbell Blvd , Clarksville TN 37042-6426. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Martin Lane, Jennifer Jo can be contacted via phone (931) 645-0346.

Contact Information

Primary practice address
1111A Fort Campbell Blvd Clarksville TN 37042-6426
Phone: (931) 645-0346
Fax: (931) 645-0348
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 3098-035 Wisconsin
Eye and Vision Services Providers / Optometrist 152W00000X 1631DT Kentucky
Eye and Vision Services Providers / Optometrist 152W00000X 3423 Tennessee

Profile Details

NPI number 1932381654
LBN Legal business name Martin Lane, Jennifer Jo
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 4th, 2007
Last updated Jan 8th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932381654 NPPES
Tennessee MEDICAID Q032337
Tennessee MEDICAID 77001501

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