Basic Information
| Provider Information | |||||||||
| NPI: | 1437170388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS. WOOD LANIER AND BOWMAN, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 RIVERSIDE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322043337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043567101 | ||||||||
| FaxNumber: | 9043567947 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 RIVERSIDE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322043337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043567101 | ||||||||
| FaxNumber: | 9043567947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 02/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | LANIER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | CURETON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 9043567101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | CK0970 | 01 | FL | RAILROAD MEDICARE | OTHER | 72844 | 01 | FL | BCBS | OTHER |