=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346332830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TODD B LANG OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 06/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 KINGS HWY
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33980-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-637-0202
-----------------------------------------------------
Fax | 941-637-0425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1521 KENSINGTON ST
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-2555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-637-0202
-----------------------------------------------------
Fax | 941-637-0425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TODD B LANG
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 941-637-0202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC 2288
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------