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General NPI Number Information
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NPI Number | 1023354610
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Entity Type | Individual
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Provider Name | LAURA LANG O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 15855 W NATIONAL AVE STE 101
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 262-923-7073
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Fax |
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Provider Business Mailing Address
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Address Line | 15855 W NATIONAL AVE STE 101
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City | NEW BERLIN
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State | WI
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Zip | 53151-5159
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Country | US
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Telephone | 262-923-7073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3267-35
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License Number State | WI
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