Provider Demographics
NPI:1083670616
Name:LANGENFELD OD, PETER (OD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:LANGENFELD OD
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 1:2465 S CRAYCROFT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-6629
Mailing Address - Country:US
Mailing Address - Phone:520-748-2020
Mailing Address - Fax:520-747-3405
Practice Address - Street 1:2465 S CRAYCROFT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-6629
Practice Address - Country:US
Practice Address - Phone:520-748-2020
Practice Address - Fax:520-747-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1200152W00000X
AZ1200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ582238810OtherTIN
AZ0905970OtherBCBS