Provider Demographics
NPI:1225652019
Name:LANG, ERICA MARIE (OD)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:MARIE
Last Name:LANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WEST AVE APT 629
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5212
Mailing Address - Country:US
Mailing Address - Phone:859-628-3739
Mailing Address - Fax:
Practice Address - Street 1:7360 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2715
Practice Address - Country:US
Practice Address - Phone:305-412-4840
Practice Address - Fax:305-412-4839
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist