Provider Demographics
NPI:1346332830
Name:TODD B LANG OD PA
Entity Type:Organization
Organization Name:TODD B LANG OD PA
Other - Org Name:BAYSIDE EYE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-637-0202
Mailing Address - Street 1:314 N.TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4839
Mailing Address - Country:US
Mailing Address - Phone:941-637-0202
Mailing Address - Fax:941-637-0425
Practice Address - Street 1:314 N. TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4839
Practice Address - Country:US
Practice Address - Phone:941-637-0202
Practice Address - Fax:941-637-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410031991OtherMEDICARE RAILROAD
FL19062OtherBLUE CROSS BLUE SHIELD
FL0341776OtherCIGNA
FL2307923OtherAETNA
FL078880500Medicaid
FL87726OtherUNITEDHEALTHCARE
FL87726OtherUNITEDHEALTHCARE
FLT61305Medicare UPIN
FL410031991OtherMEDICARE RAILROAD
FL19062OtherBLUE CROSS BLUE SHIELD