Provider Demographics
NPI:1073666053
Name:LANGHAM, JOEL L (RDO)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:L
Last Name:LANGHAM
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:BURGIN
Mailing Address - State:KY
Mailing Address - Zip Code:40310-0551
Mailing Address - Country:US
Mailing Address - Phone:859-247-0855
Mailing Address - Fax:
Practice Address - Street 1:905 HUSTONVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2160
Practice Address - Country:US
Practice Address - Phone:859-238-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1292156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician