Provider Demographics
NPI:1154326163
Name:LANGELLOTTI, RICHARD GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GREGORY
Last Name:LANGELLOTTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2310 FINLEY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4047
Mailing Address - Country:US
Mailing Address - Phone:919-924-6147
Mailing Address - Fax:919-237-9267
Practice Address - Street 1:2500 FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3461
Practice Address - Country:US
Practice Address - Phone:252-291-3939
Practice Address - Fax:252-822-0033
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1667152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891222LMedicaid
NC891222LMedicaid
NC2471743GMedicare PIN