Healthcare Provider Details

I. General information

NPI: 1033119300
Provider Name (Legal Business Name): MELANIE LYNN LANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MELANIE LYNN KAMMERS

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 DOVER RD
WOOSTER OH
44691-4105
US

IV. Provider business mailing address

961 DOVER RD
WOOSTER OH
44691-4105
US

V. Phone/Fax

Practice location:
  • Phone: 330-262-0028
  • Fax: 330-262-2808
Mailing address:
  • Phone: 330-262-0028
  • Fax: 330-262-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: