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NPI Code Detail

MEDICARE: ANDY LANGSTON OD, PA

MEDICARE:   ANDY  LANGSTON  OD, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2430AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336112465
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDY LANGSTON OD, PA
Provider Business Mailing Address
First Line : 1 PARK DR STE B
Second Line :
City : HOLIDAY ISLAND
State : AR
Zip : 72631-9221
Country : US
Telephone Number : 479-253-4040
Fax Number : 479-253-5636
Provider Business Practice Location Address
First Line : 1 PARK DR STE B
Second Line :
City : HOLIDAY ISLAND
State : AR
Zip : 72631-9221
Country : US
Telephone Number : 479-253-4040
Fax Number : 479-253-5636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 05/16/2018

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1689751257 — DR. STEVE ROSE MD
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Directions to “ ANDY LANGSTON OD, PA” Practice Location

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