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General NPI Number Information
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NPI Number | 1073666053
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Entity Type | Individual
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Provider Name | JOEL L. LANGHAM R.D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 905 HUSTONVILLE RD SUITE 1
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City | DANVILLE
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State | KY
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Zip | 40422-2160
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Country | US
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Telephone | 859-238-9448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 551
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City | BURGIN
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State | KY
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Zip | 40310-0551
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Country | US
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Telephone | 859-247-0855
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | KY-1292
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License Number State | KY
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