MEDICARE: LANGE EYE CARE & ASSOC.

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1326320001	OTHER	FL	DME

General Provider Information

NPI Number	:	1821256025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANGE EYE CARE & ASSOC.

Provider Business Mailing Address
First Line	:	3101 SW COLLEGE RD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34474-8459
Country	:	US
Telephone Number	:	352-237-3768
Fax Number	:	352-237-0561

Provider Business Practice Location Address
First Line	:	3968 SW ARCHER RD # W101
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-2342
Country	:	US
Telephone Number	:	352-376-6622
Fax Number	:	352-237-0561

Authorized Official
Title or Position	:	REGIONAL DIRECTOR
Name	:	TAMIE LANGE
Credential	:
Telephone Number	:	352-237-3768

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	10/08/2008

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