Provider Demographics
NPI:1144518010
Name:LANE, AMBER COOK (OD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:COOK
Last Name:LANE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:AMBER
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:205 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2035
Mailing Address - Country:US
Mailing Address - Phone:270-886-2020
Mailing Address - Fax:
Practice Address - Street 1:205 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2035
Practice Address - Country:US
Practice Address - Phone:270-886-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1852DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100173970Medicaid