Provider Demographics
NPI:1306941612
Name:LANGKAWEL, GRETCHEN L
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:L
Last Name:LANGKAWEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 HIGHWAY 69 SOUTH
Mailing Address - Street 2:SUITE I
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405
Mailing Address - Country:US
Mailing Address - Phone:205-752-0320
Mailing Address - Fax:205-752-0993
Practice Address - Street 1:7402 HIGHWAY 69 S
Practice Address - Street 2:SUITE I
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-1300
Practice Address - Country:US
Practice Address - Phone:205-752-0320
Practice Address - Fax:205-752-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA95TA668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526297Medicaid
AL051526297LANMedicare PIN
ALVO2574Medicare UPIN