1902112477 NPI number — DR. MELANIE KLEISER LANGFORD O.D.

Table of content: DR. MELANIE KLEISER LANGFORD O.D. (NPI 1902112477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902112477 NPI number — DR. MELANIE KLEISER LANGFORD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGFORD
Provider First Name:
MELANIE
Provider Middle Name:
KLEISER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEISER
Provider Other First Name:
MELANIE
Provider Other Middle Name:
JOANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902112477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4310 GENESEE AVE
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92117-4970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-560-5181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4310 GENESEE AVE
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-4970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-560-5181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 14061 TLG , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com