Provider Demographics
NPI:1588263537
Name:LANGE VISION CARE P.L.L.C.
Entity type:Organization
Organization Name:LANGE VISION CARE P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-430-9203
Mailing Address - Street 1:45075 W PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1257
Mailing Address - Country:US
Mailing Address - Phone:248-960-5600
Mailing Address - Fax:248-960-8049
Practice Address - Street 1:45075 W PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1257
Practice Address - Country:US
Practice Address - Phone:248-960-5600
Practice Address - Fax:248-960-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty