Provider Demographics
NPI:1174645139
Name:VANLANGEVELD, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VANLANGEVELD
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 1:1200 ALA MOANA BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-5208
Mailing Address - Country:US
Mailing Address - Phone:808-591-6601
Mailing Address - Fax:808-591-0137
Practice Address - Street 1:1200 ALA MOANA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-5208
Practice Address - Country:US
Practice Address - Phone:808-591-6601
Practice Address - Fax:808-591-0137
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10263152W00000X
HI401152W00000X
VA0618001551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI573396Medicaid
HI573396Medicaid