1952336794 NPI number — DR. TODD BRENTLEY LANG OD

Table of content: DR. TODD BRENTLEY LANG OD (NPI 1952336794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952336794 NPI number — DR. TODD BRENTLEY LANG OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANG
Provider First Name:
TODD
Provider Middle Name:
BRENTLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952336794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 KINGS HWY UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33980-4213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-637-0202
Provider Business Mailing Address Fax Number:
941-637-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 KINGS HWY UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33980-4213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-637-0202
Provider Business Practice Location Address Fax Number:
941-637-0425
Provider Enumeration Date:
07/11/2006

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:  1141 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OPC 2288 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410031991 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 19062 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0341776 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 078880500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2307923 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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