Provider Demographics
NPI:1063990026
Name:LANGOLF, ANDREA M (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:LANGOLF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 CROOKS RD
Mailing Address - Street 2:STE B
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2877 CROOKS RD
Practice Address - Street 2:STE B
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4717
Practice Address - Country:US
Practice Address - Phone:248-822-7003
Practice Address - Fax:248-822-7008
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist