MEDICARE: DR. THERESE LANGILLE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9464T	CA

General Provider Information

NPI Number	:	1164599619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESE LANGILLE O.D.

Provider Business Mailing Address
First Line	:	529 HAYES ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-4213
Country	:	US
Telephone Number	:	415-553-6166
Fax Number	:	415-553-6168

Provider Business Practice Location Address
First Line	:	529 HAYES ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-4213
Country	:	US
Telephone Number	:	415-553-6166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	05/29/2012

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Directions to “ DR. THERESE LANGILLE O.D.” Practice Location

Language	Start Address	Practice Location

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