MEDICARE: DR. TAMI R. LANG O.D.

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
1	152W00000X	Optometrist	688	AZ

General Provider Information

NPI Number	:	1720022932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMI R. LANG O.D.

Provider Business Mailing Address
First Line	:	5230 E. VILLA RITA DRIVE
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4726
Country	:	US
Telephone Number	:	602-996-9906
Fax Number	:	602-996-0943

Provider Business Practice Location Address
First Line	:	4324 E CACTUS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7636
Country	:	US
Telephone Number	:	602-996-9906
Fax Number	:	602-996-0943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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