Healthcare Provider Details

I. General information

NPI: 1780682682
Provider Name (Legal Business Name): JOHN LANGFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9046 COLUMBIA AVE # B
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

11220 ILLINOIS ST STE 220
CARMEL IN
46032-9847
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1976
  • Fax: 317-817-1737
Mailing address:
  • Phone: 317-817-1976
  • Fax: 317-817-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberIN01040840
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number1040840
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: