Provider Demographics
NPI:1316257827
Name:LANGR, KYLE (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:LANGR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 S GRAND CANYON DR (C/O DESERT CLIFFS EYECARE PLLC)
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4155 S GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7123
Practice Address - Country:US
Practice Address - Phone:507-461-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003068152W00000X
MN3752152W00000X
PAOEG004163152W00000X
WI3706-35152W00000X
NV1039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3068OtherCOLORADO OPTOMETRIC LICENSE