Provider Demographics
NPI:1295109239
Name:LANES ENTERPRISES INC
Entity type:Organization
Organization Name:LANES ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-755-7077
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1151
Mailing Address - Country:US
Mailing Address - Phone:787-755-7077
Mailing Address - Fax:787-283-7077
Practice Address - Street 1:PLAZA SAN MIGUEL SUITE 102 EXPRESO TRUJILLO ALTO.
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-755-7077
Practice Address - Fax:787-283-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR.#184-0077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty